Mueller, Alma ‘ .
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
> Name First Middle Last Sex
Alma Mueller Female
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 13 / 2016 91 _ War or Dates N/A
}-' Place of Death Hospital, Institution or
3 City, Town or Village Wilton Street Address 4382 Route 50 Apt 2
0 Manner of Death®Natural Cause E Accident E Homicide E Suicide �Undetermined Pending
W. Circumstances Investigation
al Medical Certifier Name Title
Q. John Delmonte MD
Address
3 Care Ln Suite .300, Saratoga Springs, NY 12866
ER Death Certificate Filed District Number Register Number
i>: City, Town or Village Wilton y f A j 3 _
Burial Date Cemetery or Crematory
M. 03 / 15 / 2016 Pine View Crematory
u Entombment Address
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
IS by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
iiM Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
iiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
5
) Permission is hereby granted to dispose of the human remains described above as indicated.
-'dDate Issued Registrar of Vital Statistics �`�/�J �S �G'
( gnature)
Nii District Number -- Place Wilton , New York
_ > I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z»
Ui Date of Disposition 3-/i-/, Place of Disposition /�—n e u i e.„,) G.'cyrt� 4i
SE (address)
w
0.
lc (section) \ (lot number) (grave number)
gName of Sexto I o Charge of Premises -.1 t,it vt C -sd'1C-a..e
(please print) •
W. Signature •
Title Gr2s���a
(over)
DOH-1555 (02/2004)