Rhodes, Frieda E ik
NEW YORK STATE DEPARTMENT OF HEALTH # t sI
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frieda Rhodes Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/02/2013 87 years War or Dates
.14 Place of Death Hospital, Institution or
City, Tgtr Yj Saratoga Springs Street Address
9Saratoga Hospital
Manner of Death 0 Natural CausILIe �Accident D Homicide SuicideEl Undetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
1 Amy Hogan Moulton
Address
2 Broad St., Glens Falls, N Y
Death Certificate Filed District Number Register Number
City, TAN=VOW Saratoga Springs 4501 450
❑Burial Date Cemetery or Crematory
DEntombment 11/04/2013 Pine View Cemetery
Address
";i®Cremation Queensbury N Y
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
to
Hold
Date Point of
tl
Transportation Shipment
Cs by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
iiig Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
qg Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
C
W
` Permission is hereby granted to dispose of the human remai e ri abiork ndicate
ig Date Issued 11/04/2013 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
111 Date of Disposition Place of Disposition
(address)
Lu
e (section) (lot number) (grave number)
a
ti Name of Sexton or Person in Charge of Premises
2 (please print)
ja Signature Title
(over)
DOH-1555 (02/2004)