Goren, Dorothy t �
NEW YORK STATE DEPARTMENT OF HEALTH 7T I03
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dorothy Goren Female
Date of Death Age If Veteran of U.S. Armed Forces,
09/02/2015 gg years War or Dates
F-- Place of Death Hospital, Institution or
City, TOim
�I(\ X Saratoga S rings Street Address Wesley Health Care Center
l Manner of Death❑Natural Cause 11 Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
11,1 Circumstances Investigation
.j Medical Certifier Name Title
Rink D Teetz M D
Address
131 Lawrence Street, Saratoga Springs N Y
Death Certificate Filed District Number Register Number
City, TokmVAlitritX Saratoga Springs 4501 426
ID Burial Date Cemetery or Crematory
❑Entombment 09/03/2015 Pine View Crematory
Address
[]cremation Queensbury, N Y
Date Place Removed
❑Removal and/or Held
C? and/or Address
H Hold
0 Date Point of
co Li Transportation Shipment
a by Common Destination
Carrier •
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc. 00364
Address
402 Maple Ave., Saratoga Springs, N Y
Name of Funeral Firm Making Disposition or to Whom
I_ Remains are Shipped, If Other than Above
g Address
IY
W
°' Permission is hereby granted to dispose of the human remains rib d abpv as• dicated
Date Issued 09/02/2015 Registrar of Vital Statistics
(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:
W Date of Disposition Place of Disposition tL/ Criveix
W (address)
CC (section) (lot number . (grave number)
QName of Sexton or Person in Ch ge of Premises rysa, 3cN.444-
lease print)
W Signature Title 1 4
(over)
DOH-1555 (02/2004)