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Stewart, Katherine { �j� NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit ermit Name Firstatherine Middle Last Sex Female Date of Death Age If Veteran of U.S. Armed Forces, 01/24/2014 94 years War or Dates -. Place of Death Hospital, Institution or City, TXXXXr) ?( Saratoga Springs Street Address Wesley Health Crae tliManner of Death©Natural Cause Ei Accident ElHomicide 0 Suicide ElUndetermined El Pending l Circumstances Investigation U. Medical Certifier Name Title O Rick D. Teetz M. D. Ad s 1:.ii Lawrence Street, Saratoga Springs N Y Death Certificate Filed District Number Register Number City, TX4Pgcraw Saratoga Springs 4501 40 ❑Burial Date Cemetery or Crematory 01/27/2014 Pine View Crematory ❑Entombment Address gCremation Queensbury N Y Date Place Removed ZRemoval and/or Held P ❑and/dor Address co Hol Date Point of 25 ❑Transportation Shipment L1 by Common Destination Carrier • ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care 00364 Address 402 Maple Ave., Saratoga Springs, NY Iii Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above • Address lu fl., Permission is hereby granted to dispose of the human remains de ribed above as indicated. iiii Date Issued 01/27/2014 Registrar of Vital Statistics crL -19. --41,tainc4)< (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: Z / l Date of Disposition j /�`1 /pi Place of Disposition 'f,�i VJorti) (.—cil .-- ' ► (address) ill VI CC (section) (lot number) c (grave number) II Name of Sexton or Person in Charge of remises A t.-1 SA4r40 2 (please print) ::- Signature Title Criii KO IL (over) DOH-1555 (02/2004)