Salley, Karen r
NEW YORK STATE DEPARTMENT OF HEALTH if -773
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Karen Salley Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/03/2015 59 years , War or Dates
Place of Death Hospital, Institution or
City, T°lJCJ Weifiex Street Address
Saratoga .. ings 166 Woodtawn Ave.. •
W Manner of Death Natural Cause Accident 0 Homicide ❑Suicide ❑undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Heather Madigan D.0.
Address
211 Church Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
City, Tg blatacX Saratoga Springs 4501 508
❑Burial Date Cemetery or Crematory
El Entombment 11/04/2015 Pine View Crematory
Address
❑Cremation Queensbury, N Y
Date Place Removed
Z ❑Removal and/or Held
K3 and/or Address
H Hold
/)
0 Date Point of
Di❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑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
2 Address
CC
Ct`. Permission is hereby granted to dispose of the human remai desc 'b abd'Ga i dicated
Date Issued 11/04/2015 Registrar of Vital Statistics 11
(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:
W Date of Disposition tl/SOIh Place of Disposition rwrw(or'M—
(address)
01.
CC (section) (lot number) (grave number)
GName of Sexton or Person in Ch ge of Premises 1A0,1 ease print)
Signature Title nztwliia(L
(over)
DOH-1555 (02/2004)