Coats, Lanise z5
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lanise Coats Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/26/2015 67 years War or Dates
M-± Place of Death Hospital, Institution or
WCity, MNXXX XX Saratoga Springs Street Address Saratora Hnqpjtal
Manner of Death❑,Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Richard Kim M D
Address
Death Certificate Filed District Number Register Number
City, ToXXXXVOISCIRX Saratoga Springs 4501 157
❑Burial Date Cemetery or Crematory
❑Entombment 03/27/2015 Pine View Cemetery
Address
[Cremation Queensbury N Y
Date Place Removed
Z❑r—IRemoval and/or Held
9. and/or Address
I= Hold
C? Date Point of
t �
Transportation Shipment
i3 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
Name of Funeral Firm Making Disposition or to Whom
164 Remains are Shipped, If Other than Above
Address
tt
Permission is hereby granted to dispose of the human re de ribe� as indi ted.
Date Issued 03/27/2015 Registrar of Vital Statistics 1�,/v1
(signature)
zi 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:
z
fl Date of Disposition 3130IT Place of Disposition Z,OLJ (to-gv
(address)
w
CC (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises 6h.Ht - 0.
(pl ase print)
Signature "4. Title (i7,' �"'
(over)
DOH-1555 (02/2004)