Pittman, Carol NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carol Ann Pittman Female
Date of Death Age If Veteran of U.S. Armed Forces,
06!?701t4 74 years - War or Dates
}�- Place o ea h Hospital, Institution or
Z City, To 44 Street Address
X Saratoga `' ings Saito H mined Pending
W Manner oUea Natural Cause Accident ❑Homicide ❑Suicide t�� ❑
Circumstances Investigation
W Medical Certifier Name Title
0
AdtltgSrt Irwin M D
711 Church Street, Saratoga Sprinr�s, N Y
Death Certificate Filed District Number Register Number
City, To mAgvX Saratoga Springs 4'01 304
❑Burial a e Cemetery or Crematory
❑Entombment Address06/30/2014 Pine View Cemetery
Cremation Queensbury N Y
Date Place Removed
Z Removal and/or Held
2 `-'and/or Address
Cl). Hold
0 Date ' Point of
itk❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox& Regan 01821
: Address
4111 11 Algonku .St. , Ticoncjro a NY 12883W
Name of Fu eral irm Making isposition or to hom
Remains are Shipped, If Other than Above
Address
CC
IW
CL
Permission is hereby granted to dispose of the human rem - es "bedpv s indic ed.
Date Issued 06/30/2014 Registrar of Vital Statistics
(signature)
District Number Place
4501 Saratoga Springs
IH
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
;
Ili Date of Disposition 1.z-iki Place of Disposition F ew-tyc...
2 (address)
LU
ta
IC (section) / (lot number) (grave number)
a
Name of Sexton or Person in Charge of Premises G +t � �o�'
/, ( lease print)
la
Signature �'1 LTitle Cl1454/1 1e,
(over)
DOH-1555 (02/2004)