Holland, Catherine t 3L
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
4 Name First Middle Last Sex F
.;';., Catherine L. Holland
. Date of Death.v:_3, [ Age If Veteran of U.S. Armed Forces,
r�:, 03/13/2011 i 64 War or Dates
`'. Place of Death Hospital, Institution or
City. �� Saratoga Springs Street Address Saratoga Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
. Medical Certifier am
ITitle
,:im Address
5AP4 7 c4 £PPJN 5, Ai /26-b6-
Death Certificate Filed District t RegisteN mbar
z City, lri� Saratoga Springs 1-4 SOr (
Date Cemetery or Crematory
❑Burial 03/14/2011 I Pine View Crematory
Address
,. ®Cremation Queensbury,NY
Date Place Removed
a Removal and/or Held
P. and/or Address
Hold
I Date ' Point of
%Q Transportation a Shipment
ais by Common Destination
Carrier
Disinterment Date - Cemetery Address
[�Reinterment Date ' Cemetery AddressVN
�. Permit Issued to I Registration Number
'. . Name of Funeral Home Brewer Funeral Home, Inc. 00205 —
f.:
."a., Address
24 Church St, PO Box 500, Lake Luzerne,NY 12846
A Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
i
Address
Permission is hereby granted to dispose of the human remai hod indicat .
y
Date Issued �)ly 1 / Registrar of Vital Statisticstgrn
ja (signature)
r District Number Lc ) Place SO,trC,BSc, Mori r'% ) N '`f
':wY
FI certify that the remains of the decedent identified above were disposed of in accordancerd� with this permit on:
Date of Disposition 3-0- I Place of Disposition 'I",nc.I�!e�.+ [_.��rn uriu�
(address)
la
co
(section) 4Opt number (grave number)
g Name of Sexton or Person in Charg of Premises r,a} filer one+tt
2 al
(please print)
Signature4 Title CRFMM i t' .
DOH-1555 (10/89) p. 1 of 2 VS-61