Kline, Pamela ZIC
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
,: Name First Middle Last Sex
Pamela Kline Female
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 16 / 2016 32 War or Dates N/A
}- Place of Death Hospital, Institution or
City, Town or Village Greenfield Street Address 157 Lake Desolation Road
a Manner of Death®Natural Cause 0 Accident 0 Homicide Suicide �Undetermined �Pending
liiCircumstances Investigation
lj Medical Certifier Name Title
g Timothy Nicholson MD
im Address
1184 NY-50, Ballston Lake, NY 12019
Death Certificate Filed District/Number? Registe Number
py City, Town or Village Greenfield `f'S A
0 Date Cemetery or Crematory
<:>: BUflal 03 / 21 / 2016 Pine View Crematory
0 Entombment Address
ni Cremation Queensbury, NY
M Date Place Removed
8 i❑Removal and/or Held
and/or Address
Hold
1. Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
iiiii Q Reinterment `Date Cemetery Address
iii Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
<= Address
``' 402 Maple Ave., Saratoga Springs, NY 12866
Wi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is ereby granted to dispose of the human r �_ ms,des rib` dabove as i dicated.
Oil Date Issued 3 /k/ /t., Registrar of Vital Statistic
- ( uu
(signature)
District Number q.ss-7 Place Greenfield , New York
#r-
;.:. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iti Date of Disposition 3/it/fib Place of Disposition -Rot i,:.� CI4m(ta(yv+M.
al (address)
tti
its (section) (lot number (grave number)
L" Name of Sexton or Person in Charge of Premises 4 n3io1,-i- 3i..NIt
,Z►• +(please print) •
14
Signature CI ..! Title «4.0
(over)
DOH-1555 (02/2004)