Desmarais, Claire t N 11&I
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Claire Desmarais Female
Date of Death Age 1 If Veteran of U.S. Armed Forces,
01 / 16 / 2018 80 War or Dates N/A
Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address Mary's Haven
a Manner of Death El Natural Cause 0 Accident 0 Homicide E Suicide Undetermined 7 Pending
Lti, Circumstances Investigation
tu Medical Certifier Name Title
John Delmonte MD
Address
3 Care Ln Suite 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number , Register Nu r
City, Town or Village Saratoga Springs
DBurial Date Cemetery or Crematory
Ol / 17 / 2018 Pine View Crematory
BEntombment Address
iii:i:iii or,
Cremation Queensbury, NY
Date Place Removed
Z g 7❑Removal and/or Held
and/or Address
0
Hold
Date Point of
bQ Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Ni
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
''> Address
402 Maple Ave. , Saratoga Sp., NY 12866
sf Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z Address
1Z
w
Permission is reby granted to dispose of the human remai scr' ed ab ve a indicat d.
Date Issued i') Registrar of Vital Statistics o r.
(signature)
IM
gi District Number LI 5-al Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
lit Date of Disposition /-/i^/$ Place of Disposition TM LU ,--cc,) C,,,,,,,r -
I<2 (address)
w
in (section) _ (lot number) (grave number)
II Name of Sexton or P n,. arge of Premises J L•�/I4,-0 L�444,2 4,2l -
(please print) •
Signature Title 1/ -r i �'} °7"
(over)
DOH-1555 (02/2004)