Maynard, Angeletta t . . 9
NEW YORK STATE DEPARTMENT OF HEALTH A 740
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Angeletta Maynard Female
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 23 / 2016 38 War or Dates N/A
}- Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address 16 Jefferson Terrace Apt C-2
Q Manner of Death i Natural Cause 0 Accident E Homicide 0 Suicide ❑Undetermined Pending
in Circumstances Investigation
W Medical Certifier Name Title
O Renee B. Rodriguez-Goodemote MD
Address
28 Hamilton St, Saratoga Springs, NY 12866
Death Certificate Filed District Number ��jj
���� Registej.�nr
City, Town or Village Saratoga Springs
CiBurial Date Cemetery or Crematory
10 / 24 / 2016 Pine View Crematory
0 Entombment Address
Cremation Queensbury, NY
Date Place Removed
-M❑Removal and/or Held
and/or Address
Hold
0 Date Point of
Si0 Transportation Shipment
a by Common Destination
>ii Carrier
❑Disinterment Date Cemetery Address
iig
Reinterment Date Cemetery Address
>»I
Permit Issued to Registration Number
iiiiii Name of Funeral Home Compassionate Funeral Care 00364
`_ Address
402 Maple Ave., Saratoga Sp., NY 12866
``;< Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
;1 Address
CC
l [
W. Permission is h reby ranted to dispose of the human remaiesc 'b abo icated.
`<S Date Issued j Z a' nRegistrar of Vital Statistics
11 Y (signature)
•
<`: District Number LI
5, 1 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
e
al Date of Disposition /DMZ,/,, Place of Disposition "Zit littwa (tt 1(+.
a (address)
111
CC (section)4it (lot number) (grave number)
g Name of Sexton or Person in Charge of Premises L�f� P number),.
�� • (please print) .
Signature Title t* CRfb
(over)
DOH-1555 (02/2004)