Martino, Nina NEW YORK STATE DEPARTMENT OF HEALTH
I' N # 1310
Vital Records Section Burial - Transit Permit
Name FirNsina MiddleHikari Martino Se emale
•
Date of Death Age If Veteran of U.S. Armed Forces,
02/27/2014 53 years War or Dates
Place of Death Hospital, Institution or
City, dNG{I Saratoga Springs Street Address Saratoga Hospital
tiiManner of Death 0 Natural Cause El Accident ❑Homicide ❑Suicide I—I❑Undetermined 0 Pending
ill Circumstances Investigation
iu Medical Certifier Name Title
C4 Robert Wang M D
A511.1eurch Street, Saratoga Springs, N Y
. Death Certificate Filed District Number Register Number
City, TWaXoNiktiA Saratoga Springs 4501 106
❑Burial Date Cemetery or Crematory
02/28/2014 Pine View Crematory
❑Entombment Address
`;;;;+]Cremation Queensbury, N Y
Date Place Removed
Z n Removal and/or Held
2 and/or Address
H Hold
tit)
0 Date Point of
0 Li Transportation Shipment
0 by Common Destination
Carrier
iin
❑Disinterment Date. Cemetery Address
•• ❑Reinterment Date Cemetery Address
•
!igPermit 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
tif
fL` ib a
Permission is hereby granted to dispose of the human remains` bor ' dicate
iio02/28/2014 Registrar Issued of Vital Statistics
(signature)
iiN
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:
1 .2
ILI Date of Disposition 313)14, Place of Disposition .at.) Cofot,..
2 (address)
in
0
CC (section) 4.,.
ot numbgrj (grave number)
0
Name of Sexton or Person i Charg of Premises J\t 14
z lease print)
Signature L. Title CO/own-
(over)
DOH-1555 (02/2004)