Meier, Veronica t . . !r
NEW YORK STATE DEPARTMENT OF HEALTH # -75
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Veronica - Meier Female
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 18 / 2016 79 War or Dates N/A
•
.14- Place of Death Hospital, Institution or
WCity, Town or Village Malta Street Address 14 Hunters Run
w Manner of Death Natural Cause 0 Accident ❑Homicide Suicide El Undetermined Pending
Circumstances Investigation
iti Medical Certifier Name Title
Q Kim Gendron NP
Address
433 River St., Troy, NY 12180
gliEii Death Certificate Filed District Number Register Nu ber
Ini t
City, Town or Village Malta .Tj (oC) `1 "1
OBurial Date Cemetery or Crematory
10 / 19 / 2016 Pine View Crematory
Entombment Address
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
t Hold
V.
O Date Point of
Q Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
iikQ Reinterment Date Cemetery Address
Permit Issued to ! Registration Number
[: Name of Funeral Home Compassionate Funeral Care 00364
:iiiii Address
402 Maple Ave., Saratoga Sp., NY 12866
Riiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
i, Address
Z
l
ia
`' Permission is hereby granted to dispose of the human remains describe bove as in 'cated.
in
3 Date Issued `OlVq'Ze1to Registrar of Vital Statistics c
(signatur
District Number y50 c Place Malta , New York
i,.*; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
10 a Place of Disposition 1,1• 6` `}0(�Date of Disposition //1N�ib P ,� .�
2 (address)
Ili
Er (section) /(lot number)r.- (grave number)
pName of Sexton or Person in Charge f Premises - at.iit it Spi v
Zr. (ple se punt) -
Signature �= ' `� Title at01467,C
(over)
DOH-1555 (02/2004)