Weidlich, June A g7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
June Elizabeth Weidlich Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/15/2017 91 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 Eie Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined ❑Pending
Circumstances Investigation
w Medical Certifier Name Title
d 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 566
❑Burial Date Cemetery or Crematory
11/17/2017 Pine View Crematory
El Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
S1-1Removal and/or Held
and/or Address
Hold
Date Point of
w i
❑Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q 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
rl
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/16/2017 Registrar of Vital Statistics John T'Franck, cElectronuaaySigned
(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:
` `a Date of Disposition li/1 i I i 7 Place of Disposition f v�„� C.f.,.e..4 4�
(address)
r
(section) i, (lot number) (grave number)
r
a Name of Sexton or Person in Charge of Premi es G� a,,r, 5 u.v' 4 1
lease print)
ill a
Signature - Title (i'iCMR(kG
(over)
DOH-1555 (02/2004)