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Favata, Gail
sJ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Gail Ann Favata Female Date of Death Age If Veteran of U.S. Armed Forces, 08/24/2017 64 Years War or Dates }: Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death©Natural Cause El Accident E Homicide ID Suicide ❑Undetermined El❑Pending W Circumstances Investigation ui Medical Certifier Name Title P. Jacqueline Smith DO Address 211 Church St,Saratoga Springs,New York 12866 , Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 414 ,. ❑Burial Date Cemetery or Crematory 08/29/2017 Pine View Crematorium _a: Entombment Address ®Cremation Queensbury Town, New York 1 Date Place Removed t❑Removal and/or Held F and/or Address Hold O Date Point of CO ElTransportation Shipment G by Common Destination Carrier Disinterment Date Cemetery Address ;` Reinterment Date Cemetery Address Ii Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 ot Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 - Name of Funeral Firm Making Disposition or to Whom I-- Remains are Shipped, If Other than Above Address Di aPermission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/29/2017 Registrar of Vital Statistics JohnCPTranc& Electronically Signed" (signature) 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: DiDate of Disposition QO3f(i Place of Disposition flit 0..,., 1�-b„rojart0r.. MI (address) 0 a (section) (lot number) (' (grave number) 0, Name of Sexton or Person in Charge of Premiss �'�r'I"p� J r��ar Z r/ (plebe print) ZI l4 Signature Title I IrtfUL (over) DOH-1555 (02/2004)