Urdaneta, Dorothy . . A fo-7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dorothy Lorayne Urdaneta Female
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 03 / 2016 93 War or Dates N/A
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death®Natural Cause El Accident Homicide E Suicide �Undetermined �Pending
ILICircumstances Investigation
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itj Medical Certifier Name Title
44 Maria Vivenzio DO
Address
211 Church Street Saratoga Springs NY, 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs ( 6b( --)(/
'<0Burial Date Cemetery or Crematory
02 / 05 / 2016 Pine View Crematory
a 0 Entombment Address
Cremation Queensbury, NY
Date Place Removed
*g--,
Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
iiii Carrier
igg; Q Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
`M Permit Issued to Registration Number
`:< Name of Funeral Home Compassionate Funeral Care, Inc 00364
g Address
<'= 402 Maple Ave. , Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ili
Permission is her y anted to dispose of the human remain • a bo s-in icated.
uii
iim Date Issued '2, --- I
l1' Registrar of Vital Statistics
(signature)
District Number II,---ot Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i`' �� e
iiii Date of Disposition 7-/511i Place of Disposition gritUitAl ctor&P-
(address)
Criiii
fia
(section) / (lot number) r, (grave number)
0 Name of Sexton or Person in Charge o Premises !���3��a-v �'i'w/
Z /1 (plea Se print) .
Signature (�-� Title lf ►r�}1J�.
(over)
DOH-1555 (02/2004)