Branch, Ann R 1 lot
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit erm t
Vital Records Section
Name First Middle Last Sex
Ann Branch Female
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 13 / 2016 65 War or Dates N/A
:14 Place of Death Hospital, Institution or
WCity, Town or Village Greenfield Ctr. Street Address 1580 Route 9N
O Manner of Death®Natural Cause 0 Accident E Homicide 0 Suicide 0 Undetermined 0 Pending
tki Circumstances Investigation
W Medical Certifier Name Title
a Randall L. Burchell MD
Address
''= 3044 NY-50, Saratoga Springs, NY 12866
Miii Death Certificate Filed District Number Register Number
City, Town or Village Greenfield Ctr.
Mii ElBurial Date / / Cemetery or CrematoryEntombment Pine View Crematory
Address
IIlli Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
.2 ri❑Removal and/or Held
• and/or Address
its
Hold
O, Date Point of
Q Transportation Shipment
C by Common Destination
Carrier
ii!liiii ITQ Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
>s Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
gt
Lli
• Permission is hereby ranted to dispose of the human r ains d c 'bed above as indicated.
Date Issued /IS o it, Registrar of Vital Statistic.-7fVA-t
(signature)
District Number Place Greenfield Ctr. , New York
Mg
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition K(I$i1. Place of Disposition ,;Nt).,/ mio...-
2 (address)
LLI
CC (section) drif
,. (lot?umber) (grave number)
IIName of Sexton or Person ip Charge of Pre ises tp.., ..NI'*Nit
(please print) .
u Signature t✓� Title WNW-
(over)
DOH-1555 (02/2004)