Ouimet, Colleen NEW YORK STATE DEPARTMENT OF HEALTH ' A(r,
Vital Records Section Burial - Transit Permit
Name Firsuolleen Middle Ann Ouimet Sex Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/30/2014 58 years War or Dates
F-: Place of Death Hospital, Institution or
ZCity, T�Nc Saratoga Springs Street Address Saratoga Hospital
a Manner of Death 3Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending
14,1 Circumstances Investigation
Q.
ili Medical Certifier Name Title
$ Robert Wang M D
Ad rlelsuhurch Street, Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, Te r i-ifiggeitcX Saratoga Springs 4501 49
❑Burial 1 Date Cemetery or Crematory
02/03/2014 Pine View Crematory
❑Entombment Address
-::: Cremation Queensbury N Y
Date Place Removed
Z n Removal and/or Held
2 and/or Address
F_- Hold
tO
0 Date Point of
0 ❑Transportation Shipment
a 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
Mi Name of Funeral Firm Making Disposition or to Whom
1 - Remains are Shipped, If Other than Above
2 Address
L11
"': Permission is hereby granted to dispose of the human remains-d cri d alto& indicate
Date Issued 02/03/2014 Registrar of Vital Statistics ¢
(signature)
>i District Number 4501 Place Saratoga Springs
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
la u
g .�
Date of Disposition ���IH Place of Disposition „� si H �.
2 (address)
UI
tO
CC (section) f(lot number) (grave number)
Ct
0 Name of Sexton or Pers in Charge of Premises e" Sq►./fii'
(.-I
ease print)
Signature �1----- Title MO da
(over)
DOH-1555 (02/2004)