Decker, Vera NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Vera Decker Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/21/2014 93 years War or Dates
1.4 Place of Death Hospital, Institution or
Z City, To V Street Address
�X RSC )R5(X Saratoga S rings Wesle Health Care�tF., Inc.
a Manner of Death❑JVatural Cause Accident 0 Homicide ❑Suicide u Undetermined El Pending
LLt Circumstances Investigation
tu Medical Certifier Name Title
44. Rick D. Teetz M. D.
Address
131 Lawrence Street, Saratoga Springs N Y
Death Certificate Filed District Number Register Number
City, TomexVjilitstegx Saratoga Springs _-4.c01 571
liiii❑Burial Date Cemetery or Crematory
Mi ['Entombment Address 12/23/2014 Rine View Crematory
Eil❑,cremation Queensbury, N Y
Date Place Removed
Z❑Removal and/or Held
and/or Address
= Hold
fli
0 Date Point of
0 Li Transportation Shipment
ES 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
Ii Address
402 Maple Ave.. Saratoga Springs, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
it
Permission is hereby granted to dispose of the human remain ib abgyps i dicated.
igiiii Date Issued 12/22/2014 Registrar of Vital Statistics I
(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:
iii 'Cu C Date of Disposition !Z/2�4 ill Place of Disposition ,,�, �., o1---i
(address)
W
U)
CC (section) (lot number) r (grave number)
0 dName of Sexton or Person in harge o Premises ��r�- '1 u'4
Z (please print)
iii hili Signature Title
��
(over)
DOH-1555 (02/2004)