Parry, Helen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section _ Burial - Transit Permit
y Name First Middle Last Sex
cz Helen G.Parry Female
'z Date of Death Age If Veteran of U.S. Armed Forces,
::! 12/21/2017 98 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death ci Natural Cause ❑Accident ❑Homicide El Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Maria Vivenzio DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 658
❑Burial Date Cemetery or Crematory
12/27/2017 Pine View Crematory
0 Entombment Address
®Cremation Queensbury Town, New York
e Date Place Removed
❑Removal and/or Held
and/or Address
40 Hold
Date Point of
Q Transportation Shipment
by Common Destination
= Carrier
Disinterment
Date Cemetery Address
wii
al�Reinterment-��. Date Cemetery Address
4-4
Txr
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
IA Address
11 Lafayette St,Queensbury,New York 12804
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 12/27/2017 Registrar of Vital Statistics John CPFranck E(ectronicaaySigned
i
(signature)
-, District Number 4501 Place Saratoga Springs, New York
• I certify that the remains of the decedent identified above wered disposed of in accordance with this permit on:
le is Date of Disposition J 2 /7 Place of Disposition f / V,CcJ �.'& .—% i
(address)
0
C4 (section) ,(lo number) (grave number)
Name of Sexton Per on in Charge of Premises �� t`�✓t (� e
z (please print)
III Signature Title �`='"L '�
(over)
DOH-1555 (02/2004)