Havens, Margaret Elizabeth # 1121
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Margaret Elizabeth Havens Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/10/2020 79 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
pManner of Death XINatural Cause Accident ElHomicide ❑Suicide El Undetermined El Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Timothy Reed MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 524
❑Burial Date Cemetery,Crematory or Facility Name
10/14/2020 Pine View Crematorium
❑Entombment Address
ElCremation Queensbury Hamlet,New York
❑Donation
Z ❑Removal Date Place Removed
and/or and/or Held
H N Hold Address
0
O. Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
EiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
�. Remains are Shipped,If Other than Above
5 Address
CC
W
0'' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/14/2020 Registrar of Vital Statistics John Taut Franck(ECectronicaltySigned)
(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 N)iNp I2v Place of Disposition
2 (ad ess)
W
LC N (section) (lot number) (grave number)
o Name of Sexton or Person in Charge of Pr .ses � Iv1Wl
Z (p se print)
W Signature Title L -
DOH-1555(07/18)p 1 of 2
e �
Public Health Law Sec. 4145(2b) 14 I, V 3
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# `