Loading...
Lee, Doris e, N 4 tic_ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex " Doris Carolyn Lee Female Date of Death Age If Veteran of U.S.Armed Forces, t : 06/20/2017 91 Years War or Dates i- Place of Death Hospital, Institution or ZCity, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W. Circumstances Investigation a Medical Certifier Name Title P, Eric Santell NP Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 305 ❑Burial Date Cemetery or Crematory .� 06/22/2017 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury Town, New York _`` Date Place Removed Z❑Removal and/or Held and/or Address Hold 0 Date Point of tLiTransportation Shipment 5 by Common Destination Carrier Disinterment Date Cemetery Address At''' Date Cemetery Address A ❑Reinterment 1 Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 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 06/21/2017 Registrar of Vital Statistics yohncPTranck 'Electronically Signed (signature) District Number 4501 Place Saratoga Springs, New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z, W Date of Disposition (p f23j n Place of Disposition .?rnt\L.. ()twi `-IX/a-, X (address) (section) j/ (lot number) (grave number) 11141 C? Name of Sexton or Person in Charge of Pr ises d^rTP ,S6"i4t1�' ILI ,/� fI(p/ se print) ,mi Signature L" ifi► Title 1n 1l - } (over) DOH-1555 (02/2004)