Morache, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH 0 3c-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dorothy Morache Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/12/2015 93 years War or Dates
j- Place of Death Hospital, Institution or
City, Tov ,C9XX Saratoga Springs Street Address Sarato a Hospital
Manner of Death❑,p1atural Cause ❑Accident ❑Homicide ❑Suicide lill Undetermined ❑Pending
Uj
Circumstances Investigation
W Medical Certifier Name Title
0 Catherine Dawson M n
Address
211 Church Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
City, TovY4X9WRXXXX Saratoga Springs 4501 ?4
❑Burial Date Cemetery or Crematory
❑Entombment 01/14/2015 Pine View Crematory
Address
❑cremation Queensbury, N Y
Date Place Removed
Z El❑Removal and/or Held
X and/or Address
F= Hold
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d Date Point of
to❑Transportation Shipment
Gl 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
Address
it
IU
Permission is hereby granted to dispose of the human remains ibe abovs' dicated.
Date Issued 01/14/2015 Registrar of Vital Statistics 1'
(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:
k
fU Date of Disposition (/il.lic Place of Disposition roc L 64-40n .
(address)
ill
l)
CC (section) (lot number) (grave number)
0
Name of Sexton or Person in C arge of Premises Ar,x .� ,s0.4„69-
z
I (p ase print)
„„„,!,„ Signature h- Title ',y
(over)
DOH-1555 (02/2004)