Rogers, Marguerite b30
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marguerite Rogers Female
t Date of Death Age If Veteran of U.S. Armed Forces,
08/22/2017 86 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 1,Natural Cause Accident 0 Homicide Suicide Undetermined 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 406
x ['Burial Date Cemetery or Crematory
08/23/2017 Pine View Crematory
;.:5 ['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address
= Hold
Date Point of
Q Transportation Shipment
4 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
e ❑Reinterment
s
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
IAddress
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/23/2017 Registrar of Vital Statistics j mn cP Franck, Electronica[lysigned
(signature)
Place Saratoga Springs, New York
District Number 4501
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition gl200 Place of Disposition zyu,,,, � b...
(address)
(section) of number) (grave number)
Name of Sexton or Person in Charge of Premises Jot
_�1"^6r'f'
(pletprint)
Signature / Title (OEnrtl
(over)
DOH-1555 (02/2004)