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Pike, Doris pp 5 , J NEW YORK STATE DEPARTMENTfOi- HEALTH Vital Records Section purlal - Transit Permit ' Name First Middle Last Sex Doris M Pike Female Date of Death Age If Veteran of U.S. Armed Forces, `y; 07/18/2017 84 Years War or Dates _ Place of Death Hospital, Institution or s- City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause D Accident Homicide �Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Enrico Bravo MD Address n 211 Church St,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number t City, Town or Village Saratoga Springs 4501 352 0 Burial Date Cemetery or Crematory 07/19/2017 Pine View Crematory 0 Entombment Address ®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held _ and/or Address r Hold Date Point of Q Transportation Shipment by Common Destination Carrier Date Cemetery Address 0 Disinterment El Reinterment Date Cemetery Address Permit Issued to Registration Number �::,:' Name of Funeral Home Brewer Funeral Home Inc 00211 ue Address tt 24 Church Stpo Box 500,Lake Luzerne,New York 12846 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 07/19/2017 Registrar of Vital Statistics John PTranck EfectronicailySigned (signature) District Number 4501 Place Saratoga Springs, New York 09 S Pi9 •£; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 7/20//'7 Place of Disposition f�j v i t4J� ?Z.v1 h / (address) f ' (section)) ) `. Name of Sexton erso in Charge of Premises -1 f.."-1 i—et. ( number GC—pp,/ e (grave number) (please print) .. Signature Title Cra- a--4--- (over) DOH-1555 (02/2004)