Brown, Edna . A M l'iL
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edna C. Brown Female
Date of Death Age If Veteran of U.S. Armed Forces,
03'15/2015 c16 years War or Dates
,F.- Place o Oeat Hospital, Institution or
II City, T� Saratoga S rings Street Address 35 Jefferson St I of fl24
6 Manner`o1'Dea Natural Cause Accident ❑Homicide E Suicide Undetermined Pending
ILI �—•+ Circumstances Investigation
tu Medical Certifier Name Title
O.
Mark Doyle MD
Address
135 North Road, 12831
Death Certificate Filed District Number Register Number
City, T
y cRita SaratAga SpringsLi5m 136
>> OBurial Cemetery or Crematory
❑Entombment O,110120i5 Pine View('emetery
Address
[,Cremation ^ueensbury N Y
Date Place Removed
Z ❑Removal and/or Held
and/or Address
t Hold
I
0 Date Point of
IL r—i
0 Li Transportation Shipment
a by Common Destination
ni Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate C are Inc. 00364
Address
402 Maple Avenue, Saratoga Spring, N Y 12866
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
2 Address
CC
ttf
Permission is hereby granted to dispose of the human remains 'be abo ' icated.
Date Issued p�i161201 Registrar of Vital Statistics
(signature)
District Number Place
4501 Saratoga Springs-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IL I Date of Disposition 3 jo i is- Place of Disposition n,,J,,) tor-
2 (address)
III
tal
CC (section) i (lot numb ) (grave number)
Name of Sexton or Person in Charge of Premises 'W Jw.t
5 � please print)
Signature A"t s, Title (IZEr2
(over)
DOH-1555 (02/2004)