Furey, Jennifer y
NEW YORK STATE DEPARTMENT OF HEALTH ii
Vital Records Section Burial - Transit Permit
Name First Middle. Last Sex
Jennifer A. Furey Female
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 16 / 2018 45 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Wilton Street Address 54 Field Stone Drive
p Manner of Death❑Natural Cause ❑Accident El Homicide 0 Suicide ❑ Undetermined ®Pending
Gt Circumstances Investigation
iti Medical Certifier Name Title
Susan Hayes Coroner
Address
40 McMaster Street, Ballston Spa., NY 12020
Death Certificate Filed District Number � Regiser Number
City, Town or Village Wilton /
i]ii LIBurial Date Cemetery or Crematory
09 / 18 / 2018 Pine View Crematory
El Entombment Address
EICremation Queensbury, NY
Date Place Removed
0 Removal and/or Held
c. and/or Address
Hold
0 Date Point of
TransportationCA Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
n ElReinterment Date Cemetery Address
iiiii Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
in 402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
CC
ILI
Permission is hereby granted to dispose of the human remains described above as indicated.
z Date Issued Registrar of Vital Statistics 4 G/ )W../ /f
(signature)
Ni
District Number jfl- Place Wilton , New York
I certify that the remains`` of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition Place of Disposition
2 (address)
ILS
tr (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises .
z (please print) .
Signature Title
(over)
DOH-1555 (02/2004)