Fay, Alice YI
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alice F.Fay Female
Date of Death Age If Veteran of U.S. Armed Forces,
1,4 07/03/2018 96 Years War Or Dates 1944-1946
4 Place of Death Hospital, Institution or
M. City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
tl Medical Certifier Name Title
Pt
Eric Santell NP
xt Address
$ 131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
3; City, Town or Village Saratoga Springs 4501 376
❑Burial Date Cemetery or Crematory
07/05/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date Point of
N❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
.0" Name of Funeral Firm Making Disposition or to Whom
At
I.- Remains are Shipped, If Other than Above
Address
W.
U4.4 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/05/2018 Registrar of Vital Statistics Plitt 2 Eranck(Electronica(Cy Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
aI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition "1( b IA Place of Disposition P�U� �,t,,,..t
a (address)
(e (section) (I number) (grave number)
0 Name of Sexton or Person in Charge of Premises t pi �'`
(p ease Tint)
Signature4
Title L'tz£Arq l(ft
(over)
DOH-1555(02/2004)