Carp, Kathy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name FirstKathy Middle ' Last Sex
L. Carp Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/05/2014 50 years War or Dates
ii . Place of Death Hospital, Institution or
WCity, Tov1 �XV4CX Saratoga Springs Street Address Saratoga Hospital
pi Manner of Death�latural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined 0 Pending
UCircumstances Investigation
W Medical Certifier Name Title
d Rodney Ying MD
Add ass.
b9 Myrtle Street Saratoga Springs, Ny
Death Certificate Filed District Number Register Number
:. City, ToMM\AWILX Saratoga Springs 4501 444
['Burial Date Cemetery or Crematory
10/07/2014 Pine View Cemetery
['Entombment Address
><❑Kremation Queensbury N Y
Date Place Removed
Z Removal and/or Held
C ❑and/or
Address
Hold
CA
0 Date Point of
CI'El Transportation Shipment
C3 by Common Destination
gilq Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
i
Ili
A Permission is hereby granted to dispose of the human rem " cr ed at indicat .
Date Issued 10/06/2014 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
H f'1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lit ZU
Date of Disposition 10 i1� Place of Disposition ,ne ro.s re.7[ct„►
(address)
W
ta
1 (section) (lot number) (grave number)
ta Name of Sexton or Person in Charge of remises i l. {--
z (plelase print)
ll Signature Al— Title CRZ offtrot
(over)
DOH-1555 (02/2004)