Salvi, Candance NEW YORK STATE DEPARTMENT OF HEALTH
# it/
Vital Records Section Burial - Transit Permit
Name First Middle Last Se
andace Cherry Salvi emale
Date of Death Agge If Veteran of U.S. Armed Forces,
03/07/2014 66 years War or Dates
1 Place of Death Hospital, Institution or
City, 17d i716)ror)Vci Saratoga Springs Street Address 39 Zephyr Lane, Saratoga Springs
W Manner of Death 0 Natural Cause El Accident ❑Homicide El Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Edward M. Liebers Md
AcldLess
are Lane Suite 300, Saratoga Springs, Ny
Death Certificate Filed District Number Register Number
City, IVOlfaXorXXIKVS Saratoga Springs 4501 120
❑Burial Date Cemetery or Crematory •
03/10/2014 Pine View Crematory
❑Entombment Address
]Cremation Queensbury, N Y
Date Place Removed
Removal and/or Held
❑anHoldd/or
Address
Cl)
0 Date Point of
Transportation Shipment
0 by Common Destination •
Carrier
•
Q 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
e
l
" Permission is hereby granted to dispose of the human remain rib d abog a 'ndicate
Date Issued 03/10/2014 Registrar of Vital Statistics I'
(signature)
iii 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:
2 /'
III Date of Disposition 3111 IJ Place of Disposition Ztat..) (.�'�t„,�,F®c__
a (address)
tti
tfl
CC (section) (lot nu er) (grave number)
CI Name of Sexton or Perso in Charge f Premises iv,it, t 'h9-
~z (please print)
Signature Title
(over)
DOH-1555 (02/2004) .