Hannelori, Kano if rt
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Hannelori Kano Female
Mi Date of Death Age If Veteran of U.S. Armed Forces,
09 / 13 / 2017 73 War or Dates N/A
▪ Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address 12 Reservation Ave.
0 Manner of Death®Natural Cause 0 Accident 0 Homicide E Suicide �Undetermined 0 Pending
W. Circumstances Investigation
Ca
tu Medical Certifier Name Title
Q Dr. Xiao Su MD
Address
6 Medical Park Drive Malta, NY 12020
Death Certificate Filedg District Number�D� Register,N►�9ber
City,Town or Village Saratoga Springs 2ir 5/
Burial Date Cemetery or Crematory
ni LA09 / 14 / 2017 Pine View Crematory
iiN(Entombment Address
ECremation Queensbury, NY
Date Place Removed
.❑Removal and/or Held
and/or Address
Hold
0, Date Point of
i-'''.i
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
I
Permit Issued to Registration Number
lillti Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
iiiiiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
CC
la
!" Permission is her y g nted to dispose of the human roma des ri d abbe) ndicate
Date Issued i 1 '� Registrar of Vital Statistics
q
S (signature)
iiM 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:
fit Date of Disposition 111119 Place of Disposition P ..,, Crum OOP"'
Z (address)
iiI
ilk (section) of number) (grave number)
0 Y
ci Name of Sexton or Person in Charg of Premises �..a � pN.►{�
2 A (ple print) •
,
Signature [ / Title COn OI+Q,,
(over)
DOH-1555 (02/2004)