Fowler, Kathleen t. . . 1 46t littil ,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kathleen Rose Fowler Female
Date of Death Age if Veteran of U.S. Armed Forces,
06/06/2016 64 years War or Dates
1- Place of Death Hospital, Institution or
City, To ootRVi x Saratoga S ripgs Street Address 8&Concur s St. Apt. 1Q5
a Manner of Deathatural Cause Accident u Homicide Suicide uUndeter ,ne ❑Pending
Circumstances Investigation
iii Medical Certifier Name Title
0 Robert L Flaris D O
Address
3 Iron Gate Ctr., Glens Falls, N Y
Death Certificate Filed District Number Register Number
City, Tomi7Q VJQI R X Saratoga Springs 45l1 7F7
['Burial Date Cemetery or Crematory
❑Entombment 06/08/2016 Pine View Crernatnry
Address
Dremation Queensbury, N Y
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
i= Hold
0 Date Point of
Transportation Shipment
.. by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc. 00364
Address
402 Maple Ave. Saratoga Springs, N Y
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
1
i
ii
` Permission is hereby granted to dispose of the human remains es ib abut,as' dicated.
Date issued 06/07/2016 Registrar of Vital Statistics •''`
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
U
Date of Disposition (Milt Place of Disposition lRe ✓ ��r,,C171O,...-
(address)
Ili
CC (section) (lot numb ) (grave number)
Name of Sexton or Person in Charge of PremisesA �e
2 lease print)
Signature Title C1! r` i-P i2
(over)
DOH-1555 (02/2004)