Brown, Rebecca Ad' • 41111. giir)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rebecca Brown Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/21/2018 63 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
�d Manner of Death a Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Carlos Ares MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 549
❑Burial Date Cemetery or Crematory
10/22/2018 Pine View Crematory
•❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
bx
El Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Zt Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/22/2018 Registrar of Vital Statistics John P Franck('ECectronica1TySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition I°113 lit Place of Disposition FAA1./
(address)
t
(section) (lot n ber) (grave number)
Name of Sexton or Person in Charge of Premises5'v+11�'
(please p nt)
Signature Title ti1112
(over)
DOH-1555 (02/2004)