Savitz, Caroline NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
r:r Name First Middle Last Sex
r Caroline Marie Savitz Female
:rf;;: Date of Death Age If Veteran of U.S. Armed Forces,
• September 21, 2016 25 War or Dates
r:;r Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 330 Gurney Lane
Manner of Death I XI Natural Cause Accident ( I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Eric Pillemer MD
Address
::rr Glens Falls Hospital, 100 Park St,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
. City, Town or Village Queensbury 5657 t ` 0
. ❑Burial Date Cemetery or Crematory
September 23, 2016 Pine View Crematorium
E.Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
coTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
,0.rf Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
j▪: 53 Quaker Road, Queensbury,NY 12804
:::: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
:,1: Permission is hereby granteddispose to dis ose of the human remains described above as indicated.
Date Issued 9 J 3 (aot47 Registrar of Vital Statistics
i▪ N (signature)
.1:
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 9/'231/(.� Place of Disposition p,�,Qv;e� G�ma�ot^�
2 / (address)
W
U)
O (section) /T(lot number) (grave number)
Q Name of Sexton erson ' Char a of Premises JLab.6..r1 ("a WIed-c, e
Z (please print)
W Signature i Title C/'L'sna
(over)
DOH-1555(02/2004)