Stuart, Rose 1111
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rose Stuart Female
Date of Death Age If Veteran of U.S.Armed Fecces,
10/10/2020 77 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W
`p Manner of Death l Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
V Circumstances Investigation
0 Medical Certifier Name Title
Disha Mookherjee MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 518
❑Burial Date Cemetery,Crematory or Facility Name
10/12/2020 Pine View Crematory
Entombment Address
iCremation Queensbury Town,New York
❑Donation
ZO Li Removal Date Place Removed
and/or and/or Held
- Hold Address
to
0
LL Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
f.- Remains are Shipped,If Other than Above
Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/13/2020 Registrar of Vital Statistics ,7olrn PaulFranck(EYctronica;Stgrterl)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition /0i/5 I?o Place of Disposition
2 (address)
W
to (section) (lot number) (grave number)
001)i)rkt,q- th Att1
Name of Sexton or Person in Charge of Pre s
W (pie e print) / n
Signature Title ( 1��'(
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) I * 01.4102
Receipt
Human remains of 1q;,'f delivered on , 20
•
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License