Sanders, Ronni-Jo . . I if tlgl
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ronni-Jo Sanders
Date of Death Age If Veteran of U.S. Armed Forces,
08/11/2013 .5 ca years War or Dates
1 Place of Death Hospital, Institution or
W City, TompideikleXXX Glens Falls Street Address Glens Falls Hospital
Manner of Death❑Natural Cause icident 0 Homicide 0 Suicide Undetermined Pending
f . Circumstances Investigation
tu Medical Certifier Name Title
CI Timothy E. Murphy Coroner
Address
52 Haviland Ave Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, ToV ) IiIj XX Glens Falls 5601 358
❑Burial Date Cemetery or Crematory
❑Entombment 08/19/2013 Pine View Crematorium
Address
<: ❑C,emation Queensbury, NY 12804
Date Place Removed
Removal and/or Held
❑and/Hold
or
ig Address
Cl)3
0 - Date Point of
<l3❑
a Transportation Shipment
0 by Common Destination
Carrier
AiiEl Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Street Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
#r
Ala
Permission is hereby granted to dispose of the human remains described above as in�diiccated.
Date Issued 08/19/2013 Registrar of Vital Statistics ��-A�� C!
(signature)
District Number 5601 Place Glens Falls
. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition g 11111'5 Place of Disposition -?%4 ',144 evvectrn i#-
(address)
fa
fli
LC: (section) of number) (grave number)
Name of Sexton or Pers n in Charge Premises , e ebuff
Z. (pleas print)
Signature �L �- Title CQ W.02.
(over)
DOH-1555 (02/2004)