Malloy, Alice NEW YORK STATE DEPARTMENT OF HEALTHY y' It 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alice R. Malloy Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/05/2015 89 years War or Dates
14 Place of Death Hospital, Institution or
Cown or VilineitX Greenfield Street Address 441 Rod a Road, Greenfield Center..
WManner of Death j.Natural Cause ❑Accident ❑Homicide ❑Suicide Li Undetermined ening
W. Circumstances Investigation
Ili Medical Certifier Name Title
fa Richard Orgi Attending Physician
Address
Route 2, Cropseyville, New York
Death Certificate Filed District Number Register Number
Gown or VANYJC Greenfield 4557 3
Kgi❑Burial Date Cemetery or Crematory
<i ❑Entombment 03/06/2015 Pine View Crematorium
Address
[Jremation Queensbury, New York
Date Place Removed
Removal and/or Held
2❑and/or
� Address
oa,CA
Hold
0 Date Point of
cn Li Transportation Shipment
G by Common Destination
Carrier
Q Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y12866
qii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
tr
Ili
Permission is hereby granted to dispose of the human re ns des liked above -s- dicated.
Date Issued 03/06/2015 Registrar of Vital Statistics -N
. 1 i i EA. lau,A ruL
(signature
District Number 4557 Place Greenfield
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
P
l Date of Disposition 31tof it Place of Disposition ,, 1 c»..-forv,
(address)
IL I
CO
ilk (section) it (lot numb (grave number)
Name of Sexton or Person in Charge of Premises hs .1'
Z i lease print)
tilSignature .�� Title rltiittri
0It
(over)
DOH-1555 (02/2004)