Milke, Ute '2_5-5
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
Ute Milke Female
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 25 / 2017 88 War or Dates N/A
pi Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Wesley Health Care Center
0 Manner of Death®Natural Cause �Accident Homicide _Suicide ❑Undetermined �Pending
Circumstances Investigation
JAI Medical Certifier Name Title
0 Rick D. Teetz MD
Address
iN 1134 NY-29, Greenwich, NY 12834
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 1a Ol r Vsj
rnBurial Date Cemetery or Crematory
03 / 28 / 2017 Pine View Crematory
8 Entombment Address
glii ECremation Queensbury, NY
Date Place Removed
Removal and/or Held
S. and/or Address
Hold
+iti
V. Date Point of
Q Transportation Shipment
a by Common Destination
gii Carrier
giiiQ Disinterment Date Cemetery Address
JReinterment Date Cemetery Address
€> Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
':' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
Lu
Permission is he eby anted to dispose of the human remains.deser�ibe abov`ee $indicated.
Date Issued _'�/-2 /fl Registrar of Vital Statistics 1 -
(signature)
District Number 4 6-0 I Place Saratoga Springs , New York
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fil Date of Disposition 31miin Place of Disposition 'gag v. il. +or '
(address)
iti
til
a= (section) (lot number) (grave number)
,, Name of Sexton or Person in Charge f Premises dry _06�ti�
Z
ease print) •
Signature v Title 1 MMm
(over)
DOH-1555 (02/2004)