Miller, Elaine NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
i Name First Middle Last Sex
Elaine Miller Female
gi
''' Date of Death Age If Veteran of U.S. Armed Forces,
02 / 17 / 2016 91 War or Dates N/A
14 Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Wesley Health Care
a Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide 7 Undetermined �Pending
Circumstances Investigation
ui Medical Certifier Name Title
0 Rick D. Teetz MD
•'<`3 Address
1134 NY-29, Greenwich, NY 12834
< Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs
` 90Burial Date Cemetery or Crematory
02 / 19 / 2016 Pine View Crematory
i<LIEntombment Address
Wi a Cremation Queensbury, NY
Al Date Place Removed
❑Removal and/or Held
13 and/or Address
Hold
irowtc Date Point of
❑Transportation Shipment
0 by Common Destination
Carrier
nii
Date Cemetery Address
< '0 Disinterment
< „ Q Reinterment Date Cemetery Address
iiii:s< s Permit Issued to Registration Number
E Name of Funeral Home Compassionate Funeral Care, Inc 00364
i<`:`. Address
:iiiP 402 Maple Ave., Saratoga Springs, NY 12866
iiiiiiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
* Address
Permission is hereby g dispose to dis ose of the human rem ' cr' ed a e a indicated.
Date Issued alict IUIL9 Registrar of Vital Statistics
(signature)
':':'s District Number 4501 Place Saratoga Springs , New York
iii:_z''" . I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lit Date of Disposition 7/73//i, Place of Disposition • 4,0it, r,,m ,;....
2 (address)
w
W
lC (section) A(!ot
number) (grave number)
0Name of Sexton or Person ip Charge of mises u* _, +
Zr. (p/ ase print) .
Signature a .
Title (i 1,
(over)
DOH-1555 (02/2004)