Sawyer, Mary Jane IIIo
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Jane Sawyer Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/10/2020 72 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Saratoga Springs Street Address Saratoga Hospital
`p Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Rodney Ying MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 519
ElBurial Date Cemetery,Crematory or Facility Name
10/12/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Tbwn,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment
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
I— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/13/2020 Registrar of Vital Statistics join 2'aufTranck(Electronicall:y Sign4
(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 /Of►I.('l0 Place of Disposition
W
2 (ad ess
w
N CC (section) lot number) (grave number)
gName of Sexton or Person in Charge of Premise
Z / (pie print)
W Signature /._' �- Title (► "'���`
DOH-1555(07/18)p 1 of 2
i
Public Health Law Sec. 4145(2b) 01.•41.0
Receipt
Human remains of " '' delivered on , 20
Pine View Cemetery Representing the funeral home named on),urial pexmit
Official Funeral Directors Reg.or License#