Santangelo, Lillian NEW YORK STATE DEPARTMENT OF HEALTH s �s
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lillian Santangelo Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/10/2014 90 years War or Dates
-; Place of Death Hospital, Institution or
WCity, To�pl(, iO(ViX CX Saratoga Springs Street Address Saratoga Care Nursing Home
O Manner of Death❑,Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
lL Circumstances Investigation
tu Medical Certifier Name Title
Stephen Fishel M. D.
Address
6 Medical Park Drive, Suite 208, Malta, N Y 12020
Death Certificate Filed District Number Register Number
City, ToliOXIONXIXXXX Saratoga Springs 4501 226
CI Burial Date Cemetery or Crematory
['Entombment Pine View Crematory
Address
['Cremation Queensbury, N Y
Date Place Removed
Z n Removal and/or Held
9 and/or Address
I:: Hold
iv)
0 Date Point of
❑Transportation Shipment
O 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
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
UI
a Permission is hereby granted to dispose of the human ret � s be s d s indic ed.
Date Issued 05/13/2014 Registrar of Vital Statistics t
(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
ILI Date of Disposition c_f?. Il4 Place of Disposition ?0,4/ C i'�
(address)
ill
to
ilk (section) ,(lot number) CC (grave number)
ta Name of Sexton or Pers in Charge f Premises la. `P^"'
14
Z (pase print)
14 Si nature Title canoe
(over)
DOH-1555 (02/2004)