Dejnozka, Geraldine Et 1rc
NEW YORK STATE DEPARTMENT OF HEALTH w Vital Records Section Burial - Transit Permit
Name First Geraldine Middle Last Sex
H. Dejnozka Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/20/2014 93 years War or Dates
j•- Place of Death Hospital, Institution or
CiXwn or ViXX Greenfield Street Address 315 Coy Road, Greenfield Center
a Manner of Death Adatural Cause El Accident p Homicide El Suicide n Undetermined ri Pending
li1J Circumstances Investigation
t Medical Certifier Name Title
G Jean Flanagan MD
Address
3044 Rt 50N, Saratoga Springs, NY 12866
iffi Death Certificate Filed District Number Register Number
MI Ca9Mwn or ViAirsifin Greenfield 4557 11
ElBurial Date Cemetery or Crematory
07/22/2014 Pine View Crematorium
❑Entombment Address
[ cremation Queensbury, New York
Date Place Removed
2❑Removal • and/or Held
and/or Address
t Hold
CA
0 Date Point of
t1:IDTransportation Shipment •
d by Common Destination
pii Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc. 00364
illil Address -
402 Maple Avenue, Saratoga Springs, N Y12866
lii
41 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address .
Z.
Ili
Permission is hereby granted to dispose of the human re ns descr'. _• above ass�di-�c ed.
in Date Issued 07/22/2014 Registrar of Vital Statistics IP ►
lit
(signature) I
NI District Number 4557 Place Greenfield
I certify that the remains of the decedent identified above were disposed of in accordancea with this permit on:
ILI Z et -far. '
Date of Disposition 1-Z3(1 Place of Disposition , �..
(address)
LEI
w
re (section) (lot ''Wmber) �4f'� (grave number)
ik
Name of Sexton or Person in Char a of Pre ises Fyn
Zr (please print)
W.85 Signature Title C'K"n11'1��
(over)
DOH-1555 (02/2004)