Byers, Gloria — I. #il
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gloria R.Byers Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/03/2018 92 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death gi Natural Cause Accident Homicide 0 Suicide ❑Undetermined Pending
Circumstances Investigation
44 Medical Certifier Name Title
R.
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 305
❑Burial Date Cemetery or Crematory
06/05/2018 Pine View Crematory
,,;`❑Entombment Address
f®Cremation Queensbury Town, New York
Date Place Removed
g ri Removal and/or Held
i'and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
' Carrier
s Q Disinterment
Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
,t 402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
IRemains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/04/2018 Registrar of Vital Statistics John rl'�Franck(E(ectronica((ySigned)
,,,', (signature)
`' District Number 4501 Place Saratoga Springs, New York
1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition l.O (ip Place of Disposition f'
,11, !oram-'(V"�
(address)
(section) (lot n(jn"ber) (grave number)
I1 Name of Sexton or Person in Charge of Premises !�i,., Sint) �1r
(please pr
Signatureet Title atiemitcu
(over)
DOH-1555 (02/2004)