Ryan, Constance b
NEW YORK STATE DEPARTMENT OF HEALTH _ i /�
Vital Records Section Burial - Transit Permit
Name First MiddleMiddleyan SexFemale
Date
of Death
15 A 3years If Veteran of U.S. Armed Forces,
War or Dates
J Place of Death Hospital, Institution or
i Town or)9ci Malta Street Address Home Of The Good Shepherd
a Manner of Death i:jNatural Cause El Accident 0 Homicide El Suicide niUndetermined ri Pending
Circumstances Investigation
la Medical Certifier Name Title
CI David Kandth MD
- A care Lane, Saratoga Springs, N Y 12866
Death„Ca tfjc „Filed ,,.0 -- Distnct,NumLLer_ ', :,Register Number
Town or Town Of Malta �4560: �. 11
❑Burial Date Cemetery or Crematory
02/20/2015 Pine View Crematory
Entom—..ent Address
" P3Cremation Queensbury, New York 12804
Date Place Removed
iri❑Removal and/or Held
...: and/or . Address
Hold ._
Date Point of
et 1-1
Transportation Shipment
2 by Common Destination
Carrier
Disinterment Date Cemetery Address '
Reinterment Date Cemetery Address
Permit Issued to _. Registration Number
Name of Funeral Home Compassionate Funeral Care 0364
it,,,
_Address,;:
;Y� .402 Maple Ave, Saratoga Springs, NY 12866
` Name of Funeral Firm Making Disposition or to Whom
JRemains_
are Shipped, If Other than Above
Address
I . •
Permission is hereby granted to dispose of the human remain escri ed ab e s indica ed.
Date Issued- 02/20/2015 Registrar of Vital Stati` . C . -'
// signature)
District Number 4560 Place Town Of Malta
I certify that=the.:remains of the decedent identified a ve ere disposed of in accordance ' is permit on:
date of Disposition 7lZ hS Place of Disposition t""1"" - ---
(address)
(section) ' (lot number (grave number)
Name of Sexton or Person in Charge of Premises /4.� -nt)1Q
al .
(pease pri
Signature` 4 Title =ati,itlyi2
(over),
DOH,1555 (02/2004)