King, Mary NEW YORK STATE DEPARTMENT OF HEALTI- % # 60
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary T. King Female
Date of Death Age If Veteran of U.S. Armed Forces,
09/24/2014 77 years War or Dates
Place of Death Hospital, Institution or
kown or Yawn Greenfield Street Address 11ft Saratoga Rlvr, Saratngga S ringq N Y 19866
0 Manner of Death Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending
W. Circumstances Investigation
iti Medical Certifier Name Title
Tracey Boennan Attending Physician
Address
324 West Avenue, Saratoga Springs, N Y 12866
liiii Death Certificate Filed District Number Register Number
ii.l.iiii.i Chi Town or'4( X Greenfield 4557 18
>>❑Burial Date Cemetery or Crematory
09/24/2014 Pine View Crematorium
❑Entombment Address
°Cremation Queensbury, New York
Date Place Removed
� Removal and/or Held
and/or Address
F Hold
ID
Q Date Point of
Transportation Shipment
O by Common Destination
iiM Carrier
Q Disinterment Date Cemetery Address
IRII,IQ Reinterment Date - Cemetery Address
s Permit Issued to Registration Number
gi!i Name of Funeral Home Compassionate Funeral Care, Inc. 00364
ig Address
402 Maple Avenue, Saratoga Springs, N Y12866
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
2 Address
ill
• Permission is hereby granted to dispose of the human remains described above as indicated.
iin Date issued 09/25/2014 Registrar of Vital Statistics ,--._..-
(signature)
': District Number 4557 Place Greenfield
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition h l lgify Place of Disposition Z,,,,i ,ispir,,,.,
(address)
L
Cl)
re (section) //(Iqt numb r) (grave number)
Ci
tt Name of Sexton or Person in Charge of Premises (hr.f J'^r#
z (plse print)
Signature tid Title Cat► llfy
(over)
DOH-1555 (02/2004)