Steward, Marilyn 4 # Ygg
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
t Marilyn M Steward Female
0 Date of Death Age If Veteran of U.S. Armed Forces,
06/27/2017 62 Years War or Dates
`%, Place of Death Hospital, Institution or
ri City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death X❑Natural Cause ❑Accident ❑Homicide EI Suicide El Undetermined 17 Pending
Circumstances Investigation
x Medical Certifier Name Title
Carlos Ares MD
- Address
211 Church St,Saratoga Springs,New York 12866
, 4
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 317
: ❑Burial Date Cemetery or Crematory
06/29/2017 Pine View Crematory
❑Entombment
r� Address
:.
®,_, Cremation Queensbry, New York
't Date Place Removed
:.: ❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
5 Date Cemetery Address
, Q Reinterment
[(44
b 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 06/29/2017 Registrar of Vital Statistics .ofinIFranck EfectronicaaySigned-
# (signature)
District Number 4501 Place Saratoga Springs, New York
rl I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
" Date of Disposition ` 330 Place of Disposition 'f ntOti,/ tau
(address)
(section) ,v(lot number) (grave number)
Name of Sexton or Person in Charge of remises (it Simdlt
, " (p/e a print)
aSignature 1 Title Midi
(over)
DOH-1555 (02/2004)