Thomas, Debra i
NEW YORK STATE DEPARTMENT OF HEALTH # 7$S—
Vital Records Section Burial - Transit Permit
i Name First Middle Last Sex
Debra Ann Thomas Female
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 22 / 2015 49 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address 8 Vanderbilt Ave
0 Manner of Death®Natural Cause E Accident El Homicide E Suicide �Undetermined Pending
• Circumstances Investigation
tu Medical Certifier Name Title
0 Daniel J. Kuhn
Address
40 McMaster St. , Ballston Spa., NY 12020
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs L� . L1 q 7
's' Burial Date Cemetery or Crematory
tory
10 / 30 / 2015 Pine View Crematory
Pig(Entombment Address
Ni Cremation 21 Quaker Road,Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
40
Hold
Date Point of
Q Transportation Shipment
by Common Destination
in Carrier
: ?Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
pi
iali Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Rii Address
0. 402 Maple Ave. , Saratoga Springs, NY 12866
mi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ir
iii
Permission is h eby anted to dispose of the human remai scri ed abo e as indicated.
Date Issued ,...2
j'S Registrar of Vital Statistics
(signature)
District Number y Sbt Place Saratoga Springs , New York
91
: "` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
AU Date of Disposition if!L fir Place of Disposition -eds., errerfkc ...-
(address)
ILI
In
2 (section) (lat•numbe) (grave number)
gName of Sexton or Person in Charge of Premises �' (fin
2 ��'(p ase punt)
1.0 Signature Title
(over)
DOH-1555 (02/2004)