Bugbee, Mary z0
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Jane Bugbee Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/25/2016 84 years War or Dates
I- Place of Death Hospital, Institution or
City, ToX 7I\MCII X Saratoga Springs Street Address Saratoa Hnspital
a Manner of Death(,Natural Cause O Accident O Homicide O Suicide Undetermined Pending
Circumstances Investigation
la Medical Certifier Name Title
0 Numan Rashid M D
Address
Death Certificate Filed District Number Register Number
City, ToWAXIXAMIXX Saratoga Springs 4501 606
OBurial Date Cemetery or Crematory
['Entombment12/27/2016 Pine View Crematory
Address
[Cremation Queensbury, N Y
Date Place Removed
Z Removal and/or Held
9- ❑and/or/or Address
Hold
itl
0 Date Point of
t' Transportation Shipment
by Common Destination
Carrier
O Disinterment Date Cemetery Address
O Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Springs, NY
Name of Funeral Firm Making Disposition or to Whom
!„- Remains are Shipped, If Other than Above
Address
#r.
W
Permission is hereby granted to dispose of the human remai a ri d aboBeasindicate .
Date Issued 12/27/2016 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:
lILI Date of Disposition)2/2 //10 Place of Disposition /,YI s'v ;�.vtil Cc i i
W (address)
CC (section) /(lot number) (grave number)
aName of Sexton r,Perso in Charge of Premises J i.. /i c:d o Oc vn4. -Z €.
(please print)
Signature Title C rC 4-71(.' ✓
(over)
DOH-1555 (02/2004)