Montero, Mildred NEW YORK STATE DEPARTMENT OF HEALTII g�0
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mildred Marie Montero Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/18/2017 74 Years War or Dates
I Place of Death Hospital, Institution or
City, Town or Vfttage Glens Faffs I Sit eet Address Glens Fes Hospftat
Manner of Death IT Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending
Circumstances Investigation
Medical Certifier Name Title
Sean Bain MD
Address
100 Park St,Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 597
/, ❑Burial Date Cemetery or Crematory
11/21/2017 Pine View Crematory
,; ❑Entombment Address
®Cremation Queensbury Town, New York
. Date Place Removed
Removal and/or Held
and/or Address
Hold 1
Date Point of
co❑Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
A Q Reinterment Date Cemetery Address
w
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
*,,j Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
P-1 Remains are Shipped, If Other than Above
Address
LLI
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/21/2017 Registrar of Vital Statistics cg6ertACurtis 'ECectronicaaySigned'
(signature)
, District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition r'j/23117 Place of Disposition Cu ._.- a 0A....
(address)
(section) (lot number (grave number)
Name of Sexton or Person in Charge of Premises a. • w+% `
'". /1 ✓✓ (please pn
W Signature Gr( Title (WIC-n1AM
(over)
DOH-1555 (02/2004)