Hazen, Katherine if7 ii,r
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Katherine A.Hazen Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/06/2017 91 Years War or Dates
Place of Death Hospital, Institution or
;1 City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
j Medical Certifier Name Title
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 492
❑Burial Date Cemetery or Crematory
10/09/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
44 Removal and/or Held
and/or Address
Hold
412
O Date Point of
Transportation Shipment
by Common Destination
Carrier
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
tst4 Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
Address
1
Permission is hereby granted to dispose of the human remains described above as indicated.
ge
Date Issued 10/09/2017 Registrar of Vital Statistics John Prank Electronically Signed"
7; (signature)
ti
District Number 4501 Place Saratoga Springs, New York
* I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iic
1LI Date of Disposition lb I10117 Place of Disposition °'^4‘i ey,..cf0ri...
I (address)
M (section) �J(lot number) (grave number)
Name of Sexton or Person in Charge f Premises {'^' SQ��
Signature Title (ple se print)
0Grp 01CA
(over)
DOH-1555 (02/2004)