Morton, Rosemary NEW YORK STATE DEPARTMENT OF HEALTH �f0
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rosemary Ann Morton Female
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 02 / 2017 65 War or Dates N/A
16. Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital
W.
Manner of Death El NaturalCause 0 Accident ❑Homicide ❑Suicide 0 Undetermined 0 Pending
Circumstances Investigation
La Medical Certifier Name Title
O Mark H. Weidner MD
gil Address
2 Broad Street Plz # 101, Glens Falls, NY 12801
Death Certificate Filed District Number Register N ber
MI City,Town or Village Saratoga Springs
El
Date Cemetery or C�em• ato
ly
;oi:::?;: 04 5 2017
/ 0 / Pine View Crematory
0 Entombment Address
Cremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
0
Hold
Date Point of
1 Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Ei
Q Reinterment Date ' Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
in
Name of Funeral Firm Making Disposition or to Whom
bi Remains are Shipped, If Other than Above
11. Address
Z
Kt
Permission is h eby granted to dispose of the human remains-describ d above as indicated.
,:*,],. Date Issued ' Registrar of Vital Statistics • (�� • -- r
,ft
(signature)
)
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District Number Place Saratoga Springs , New York
'.<_:;::• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition q I(� Place of Disposition ProL Gft Mci`(a•4.-.
(address)
tti
lr (section) (lo umber) it(grave number)
tzt Name of Sexton or Person L Charg of Premises SMm tit
Z e' (please rint) •
• Signature u Title cm1 1�✓(L
(over)
DOH-1555 (02/2004)