Green, Catherine 1 Irli R, t"ia:...
NEW YORK STATE DEPARTMENT OF HEALTH g
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Catherine Green Female
Date of Death Age If Veteran of U.S. Armed Forces,
0.
04 / 11 / 2016 69 War or Dates N/A
1- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address
iLl Saratoga Hospital
0 Manner of Death Natural Cause 0 Accident 0 Homicide D Suicide �Undetermined �Pending
0111
Circumstances Investigation
in Medical Certifier Name Title
Q. Timothy R. Waters DO
Address
211 Church Street Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
LJ City, Town or Village Saratoga Springs ' '(-)f ��.-
fl Burial Date r Cemetery or Crematory 11
/ i Z/ 2.0 ` r Pine View Crematory
>' El Entombment Address
Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
ht and/or Address
t Hold
O.
Date Point of
Q Transportation Shipment
>S by Common Destination
Carrier
Mii
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
im
Permit Issued to Registration Number
ip
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
tr
ILI
p" Permission is h reby granted to dispose of the human remai s des ri abo4�abdicated
ligDate Issued '2 j( , Registrar of Vital Statistics ( -f'
(signature)
District Number Li 5—et Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ,I
tti Date of Disposition q((3'1b RAU
Place of Disposition — C 46....
2 (address)
LEI
CC (section) /I/(lot number) (grave number)
aName of Sexton or Person in Charge f Premises 6 b�s Slr '
Z
(p/e a print) .
Signature (mil Title /At
(over)
DOH-1555 (02/2004)