Blessing, Jayne NEW YORK STATE DEPARTMENT OF'HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jayne Elizabeth Blessing Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/24/2018 66 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 0 Natural Cause 0 Accident 0 Homicide 0Suicide ri Undetermined r i Pending
Circumstances Investigation
lb Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 475
❑Burial Date Cemetery or Crematory
08/27/2018 Pine View Crematory
r ❑Entombment-Address
®Cremation Queensbury Town, New York 1
Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date Point of
;1.Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment
Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
t k
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
Address
fr
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/27/2018 Registrar of Vital Statistics .gohnTEranck(ECectronica1TySigned)
(signature)
District Number Place
4501 Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
p k g Place of Disposition fat itoort"dr ,
Date of Disposition S�sa p
(address)
ti
(section) (tot number) (grave number)
41 I�t j
Name of Sexton or Person in Charge of Pre ises anotf
eee���
0) f-
/� (pl se print)
rl Signature /(�� Title '����(,
(over)
DOH-1555 (02/2004)