Holzschuh, Margaret t _
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit 74erirli
Name First Middle Last Sex
Margaret Theresa Holzschuh Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/23/2017 83 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
1. Manner of Death Natural Cause ❑la" Accident ❑Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Suzanne Rayeski DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 450
Burial
Date Cemetery or Crematory
08/28/2017 Pine View Crematory
El Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
El Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
17, Address
he
r`3 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/24/2017 Registrar of Vital Statistics Rp6ertACurtis TCectronicaaySigned'
(signature)
District Number 5601 Place Glens Falls, New York
• 1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iCrfk Date of Disposition Ei3o Ii7Place of Disposition `h pp,,J„„ 4 w•cc^w
(address)
11
® (section) ' (Iqt number) (grave number)
173
Name of Sexton or Person in Charge of Premises L IV:. - �„wit
e (p/ se print)Signature b ign�c�Title l �t
(over)
DOH-1555 (02/2004)