Blaisdell, Elsie NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
Elsie W.Blaisdell Female
• Date of Death Age If Veteran of U.S. Armed Forces,
09/14/2018 95 Years War or Dates
Place of Death Hospital, Institution or
7, City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death ji,ENatural Cause ❑Accident ❑Homicide ❑Suicide Undetermined El❑Pending
Circumstances Investigation
Medical Certifier Name Title
Diane Westbrook NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
• Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 501
Date Cemetery❑Burial or Crematory
09/14/2018 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
SEA Carrier
❑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
- Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued 09/14/2018 Registrar of Vital Statistics John crFranck/EfectronicaLTySigned)
(signature)
• District Number 4501 Place Saratoga Springs, New York
Ie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 111i lig Place of Disposition
(address)
(section) (lot pnumber) (grave number)
Name of Sexton or Person in Charge of remises 64n4rS L,nti{r
(please pri, t)
. H)4_
Signature Title
(over)
DOH-1555 (02/2004)