Constantine, Joan 4 Mr 1
A . W- 71g
NEW YORK STATE DEPARTMENT OF„HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joan H. Constantine Female
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 13 / 2016 73 War or Dates N/A
i. Place of Death Hospital, Institution or
Z City, Town or Village Saratoga SpringsIiiii- Street Address Saratoga Hospital
Manner of Death 7 Natural Cause 0 Accident 0 Homicide 0 Suicide 7 Undetermined 7 Pending
Circumstances Investigation
iii Medical Certifier Name Title
44 Off14,VE thiaSoN An-EtVit4 fidysicrX
Address
7(1 (1.14Cii Sr SARMVry Sfia-Ng W. iz
aDeath Certificate Filed District Number Register Number
in City, Town or Village Saratoga Springs y 50 j
iiiii ]Burial Date Cemetery or Crematory
' 10 / 17 / 2016
Pine View Crematory
ElEntombment Address
pii MCremation Queensbury, NY
mi
Date Place Removed
2 ❑Removal and/or Held
and/or Address
14 Hold
f Date Point of
tl
• Transportation Shipment
O by Common Destination
:<, Carrier
[�Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
i>: Permit Issued to Registration Number
al Name of Funeral Home Compassionate Funeral Care 00364
iigil Address
402 Maple Ave., Saratoga Sp., NY 12866
iiiiiiii! Name of Funeral Firm Making Disposition or to Whom
.14 Remains are Shipped, If Other than Above
. Address
te
LEI
Permission is her by g anted to dispose of the human remaindescribed above as indicated.
Date Issued ]� 't Registrar of Vital Statistics t_L jk
(signature)
District Number ! ICj Place Saratoga Springs , New York
c
f:i
"<. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
#'►
z r Ca,,nn
111 Date of Disposition /Oltjfb �ia Place of Disposition fikint...-
X (address)
lit
0
E (section) (lot number)
(` (grave number)
Name of Sexton or Person in Charge of Premises t���' �/ Sl,
( lease print)
SignatureZit Title c'
414-742
(over)
DOH-1555 (02/2004)