Rafferty, Deborah NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Deborah Anne Rafferty female
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 31 / 2015 39 War or Dates
}- Place of Death Hospital, Institution or
• City, Town or Village Queensbury Street Address
Manner of Death❑Natural Cause 0 Accident 0 Homicide ®Suicide riUndetermined Pending
Circumstances Investigation
1, Medical Certifier Name Title
a Michael Sikinica MD
Address
50 Broad St., Waterford, NY 12188
< Death Certificate Filed D ict m r A isterr Number
_< City, Town or Village Queensbury l Lt
i.PLOBurial Date Cemetery or Crematory Pine View Crematory
11 / 08 / 2015
?"':.? ®Entombment Address
>3 ECremation 21 Quaker Rd, Queensbury, NY
iiii Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
iiiig Carrier
ii Q Disinterment Date Cemetery Address
Q Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
iiiRi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby pranted to dispose of the human a ins described bove ass indicated.
Date Issued 1 / 1 c-- 6C)tcRegistrar of Vital Statistics CI a-,----,
Mg (signature)
IliR District Number c) Place Queensbury , New York
7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition MD)IS" Place of Disposition 1 ,L1 L onK, ra-•-
(address)
til
til
CC (section) (lot numbed. (grave number)
0 Name of Sexton or Person - Charge of remisesrt1i(pJease print)^
1-4:4: a Signature Title
It stbS_
•
(over)
DOH-1555 (02/2004)