Meade, Jeannine . , ., f tig V
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
iiiEi Name First Middle Last Sex
Jeannine Louise Meade Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/02/2016 50 years War or Dates
1-- Place of Death Hospital, Institution or
Z City, ToW)vW XX Sara Street Address
1t;E toga rings Wesle Hgaft Care.Center
a Manner of Death EJJ'latural Cause Accident 0 Homicide Suicide ii Undetermined Pending
W. Circumstances Investigation
in Medical Certifier Name Title
0 Fdit Masaba MD
Address
35 Gilbert St, Cambridge, N Y 12816
Death Certificate Filed District Number Register Number
City, ToXyQ XX Saratoga Springs 4,5n1 306
0 Burial Date Cemetery or Crematory
❑Entombment 07/05/2016 Pine View Crematorium
Address
gi DCremation Queensbury, N Y
Date Place Removed
❑Removal and/or Held
and/or
F Address
t
Hold
0 Date Point of
Transportation Shipment
L1 by Common Destination
igii Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
iiii Name of Funeral Home Barton-mcdermott Funeral Home 00141
>' Address
9 Pine Street, Chestertown, N Y
il Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
fu
P:` Permission is hereby granted to dispose of the human remai e ri abop ' dicate
lii Date Issued 07/05/2016 Registrar of Vital Statistics
(signature)
gilil District Number 4501 Place Saratoga Springs
pii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition '7/Ib lit, Place of Disposition nc u.� l o--'
2 (address)
ill
CC (section) i (lot number) (grave number)
CI Name of Sexton or Person in Charge of P emises 6�~^J ✓ e~ b^v' "
(please print)
Signature a Title CZ P ► __
(over)
DOH-1555 (02/2004)