Gilmore, Claudia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Claudia Karam Gilmore Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/05/2014 59 years War or Dates
14 Place of Death Hospital, Institution or
il City, To V Street Address
�9f9CR�C ACX Saratoga S rings Sa rat Hospital
a Manner of Death ,Natural Cause Accident 0 Homicide 0 Suicide ?Undetermined 0 Pending
t t Circumstances Investigation
tij Medical Certifier Name Title
C Ad Jresssoan Bernad M D
211 Church Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
City, Tovxritg6(Vh519rx Saratoga Springs 11501 219
['Burial Date Cemetery or Crematory
❑Entombment n5/nR/,n14 Pin.view r'emetery
Address
[premation Oueensbitry N Y
Date Place Removed
Z2❑Removal and/or Held
and/or Address
It Hold
to
0 Date Point of
00 Transportation Shipment
ci by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Carp, Inc_ 00361
Address
402 Maple Avenue, Saratoga Springs,N Y 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t
11
CL
Permission is hereby granted to dispose of the human re es 'bed a ve s indicated.
Date Issued 05/07/2014 Registrar of Vital Statistics ''11))/M�
(signature)
District Number Place
4501 Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tLI Date of Disposition c'(i')ti Place of Disposition
C1:---
(address)
Ili
1X (section) L�' (lot number) S (grave number)
Name of Sexton or Perso in Charge of Premises r j tc+f4i-
/� ( ease print)
its Signature / �l- -- Title awEIVOI
(over)
DOH-1555 /02/2004)