Kane-Parker, Marilyn 9z7
NEW YORK STATE DEPARTMENT OF'HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marilyn Kane-Parker Female
Date of Death Age If Veteran of U.S. Armed Forces,
• 12/23/2016 61 years War or Dates
}- Place of Death Hospital, Institution or
City, T�@174XIRVII*XX Saratoga Springs Street Address Sarato a Hnsptta)
Manner of Death❑,Natural Cause ❑Accident ❑Homicide ❑Suicide J Undetermined ❑Pending
Ul Circumstances Investigation
ju Medical Certifier Name Title
C Stephen Offord Md
Address
211 Church Street, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, T0X00XXV(DEXIXX Saratoga Springs 4501 605
❑Burial Date Cemetery or Crematory
12/27/2016 Pine View Crematory
i ❑Entombment Address
QCremation Queensbury, N Y
Date Place Removed
Z Removal and/or Held
2 ❑and/or Address
I::
Cl
Hold
0 Date Point of
5 0 Transportation Shipment
ct by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Springs, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
1r.
in
Permission is hereby granted to dispose of the human remai rib abar. . dicate
Date Issued 12/27/2016 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition I?Jzy; i Place of Disposition 21 I eu i e,,t) (�/C�-EL�o/�
2 / (address)
lit
VI
CC (section) 11 (lot nun per) (grave number)
fa Name of Sexton o on in Charge of Premises Nj t -li c.,4 C�6w4-0.6G,-L
z. (please print)
41
Signature ‘ZA Title Lt2-.114 Li-ei* -
• (over)
DOH-1555 (02/2004)