Early, Irene NEW YORK STATE DEPARTMENT OF HEALTH 1 Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Irene Early Female
/Date of Death Age If Veteran of U.S. Armed Forces,
09 / 05 / 2016 86 T War or Dates N/A
I=- Place of Death Hospital, Institution or
1Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Q Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide 7 Undetermined 0 Pending
W. Circumstances Investigation
tti Medical Certifier Name Title
Q Catherine Dawson
Address
211 Church St., Saratoga Springs, NY 12866
Death Certificate Filed District Number LEI()l Register Number q
City, Town or Village Saratoga Springs
(Burial Date G / 2/ !/C,C) I f Cemetery or Crematory
Entombment J b Pine View Crematory
ni ElEs Address � ,�ICn
X Cremation Z,�` (l.�t. � Queensbury, NY
Date Place Removed
0 Removal and/or Held
2? and/or Address
Hold
Date Point of
Transportation Shipment
E: by Common Destination
Carrier
in
Disinterment Date Cemetery Address
<.:: Date . Cemetery Address
Q Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
iiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
!r.
i2
11 Permission is hereb granted to dispose of the human remain 'be abovs' icated.
i€ Date Issued (11 LS�1 _ Registrar of Vital Statistics
(signature)
ni
District Number 45n Place Saratoga Springs , New York
F+ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tit Date of Disposition 1(1111) Place of Disposition ?IV ILA/ ekMqitdtt,
2 (address)
f+it
Q (section) (lot number) (grave number)
gName of Sexton or Person in Charge o Premises firm e. SLo9I*'
z ( lease punt)
Signature Title Ca 0024
(over)
DOH-1555 (02/2004)