Morris, Karen i ‘ 3 V
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Karen Morris Female
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 05 / 2016 75 War or Dates N/A
}- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Mary's Haven
Uj
4 Manner of Death E Natural Cause 0 Accident 0 Homicide 0 Suicide � Undetermined �Pending
Ili Circumstances Investigation
0.
tu Medical Certifier Name Title
44 John P. Mongan DO
Address
6 Medical Park Drive #200, Malta, NY 12020
ig Death Certificate Filed District Number ii5DI
Register Number1,ji
City, Town or Village Saratoga Springs '��1
: OBurial Date /� / ? / j/ Cemetery or Crematory
QEntornbment ` l(D Pine View Crematory
s Addres
remation 2 ( (,t Ct 1 Queensbury, NY
Date Place Removed
ZZ Removal and/or Held
fa❑and/or Address
Hold
0 Date Point of
fili 0 Transportation Shipment
is by Common Destination
Carrier
Ni p Q Disinterment Date Cemetery Address
:'ig
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
iiiiiiiii Name of Funeral Home Compassionate Funeral Care 00364
Address
iiiii
402 Maple Ave., Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
. Address
IC
111
44.
Permission is lig hereby granted to dispose of the human remain be aboytis i icated.
Date Issued q/[Q)2Dfl.P Registrar of Vital Statistics 1 -
nii (signature)
iiiiig District Number 451 Place Saratoga Springs , New York
fi- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Iti Date of Disposition 'tI$ii6 Place of Disposition LOle,.i 4-1yncefor,uv\
2 (address)
iil
cc (section) driftir
(lot number) (grave number)
CI Name of Sexton or Person in Charg of Premises • . �ti4Z ease print) .
iii
Signature _.. Title Cl2j mo
(over)
DOH-1555 (02/2004)