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Atwood, Minerva ..4 t NEW YORK STATE DEPARTMENT OF HEALTH - ' Permit Vital Records Section BurialTrans!Tr Name Firstinerva MiddleGene LAttwood Sex Female Date of Death Age If Veteran of U.S. Armed Forces, 04/02/2014 89 years War or Dates }.•.. Place of Death Hospital, Institution or Z City, TUPTgr MiXelfiX Saratoga Springs Street Address Saratoga Hospital ILI Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending ILI Circumstances Investigation til Medical Certifier Name Title p Catherine Dawson M D Ad i11 church Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number City, Txr 04 Saratoga Springs 4501 164 []Burial Date Cemetery or Crematory 04/04/2014 Pine View Crematory ❑Entombment Address OCremation Queensbury, N Y Date Place Removed Z Removal and/or Held P.,❑and/or Address 1- Hold Cl) 0 Date Point of titS 0 Transportation Shipment G by Common Destination Carrier El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address >: Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care, Inc. 00364 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 2 Address IX tU CL Permission is hereby granted to dispose of the human remains escri d ,,oThv 'cated. Date Issued Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs IE- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tLI Date of Disposition Li h i)"I Place of Disposition 'lrrf ttvJ Ci@rmiorivv- 2 (address) ILI Cr (section) 1 .(lot number (grave number) aName of Sexton or Person . Charge o Premises / r k Z. lease print) >: Signature FL Title Ciit FIN (over) DOH-1555 (02/2004)