Symonds, Annmarie iLI ,
NEW YORK STATE DEPARTMENT OF HEALTH A. )
Vital Records Section Burial - Transit Permit
Name First Middle Las/ Sex
Annmarie C. 5ymonds Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/15/2013 70 years War or Dates
1 Place of Death Hospital, Institution or
C wn or ViXilf XX Greenfield Street Address 1731 Route 9 N
141
W Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined El Pending
Circumstances Investigation
ut Medical Certifier Name Title
0 James J. Murray M D
Addrts�ircular Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
Cil9R4wn or ViiMAXX Greenfield 4557 4
❑Burial Date Cemetery or Crematory
03/18/2013 Pine View Crematorium
0 Entombment Address
❑atemation Queensbury, New York
Date Place Removed
Z Removal and/or Held
21—jand/or Address
IAA Hold
0 Date Point of
Q Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to RegistI tiQn Number
Name of Funeral Home Compassionate Funeral Care, Inc.
Address
402 Maple Avenue, Saratoga Springs, N Y12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
it
ILI
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/18/2013 Registrar of Vital Statistics
(signature)
District Number 4557 Place Greenfield
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LU Date of Disposition 3'((?-I-3 Place of Disposition AN/4.../i 44-4/ CieF.ivi4 I7j(2-�
(address)
ILI
1.0
CC (section) gumbyr) (grave number)
aName of SextonJPersn in a of Premises //
2 I (please print)
Signature la ,lid.l Title �i!'7✓/'f0� �/
(over)
DOH-1555 (02/2004)