Malone, Juanita � P low
NEW YORK STATE DEPARTMENT OF HEALTH -
Vital Records Section Burial - Transit Permit
Name First Middle t
Juanitas Viaslone Se'Female
o. Date of Death Age If Veteran of U.S. Armed Forces,
03/08/2013 82 years War or Dates
Place of Death Hospital, Institution or
City, larXXo�Clbt j Saratoga Springs Street Address Saratoga Hospital
• Manner of Death®Natural Cause Ej Accident 0 Homicide El Suicide 0 Undetermined ri Pending
itit Circumstances Investigation
ta Medical Certifier Name Title
fl Stephen Offord Md
A irMyrtle St, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, ICX*Xo j Saratoga Springs 4501 120 '
Burial Date Cemetery or Crematory
03/11/2013 Pine View Crematory
❑Entombment Address
;EinCremation Queensbury N Y .
Date Place Removed
Z Removal and/or Held
2❑and/or
F- Hold Address
to
O Date Point of
iri
Q Transportation Shipment
O by Common Destination
Carrier •
ID Disinterment Date Cemetery Address
❑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
ip Name of Funeral Firm Making Disposition or to Whom
1-, Remains are Shipped, If Other than Above
2 Address
Lu
` Permission is hereby granted to dispose of the human remai scr ed b v indicat d.
gii Date Issued 03/11/2013 Registrar of Vital Statistics r.
(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:
E
La Date of Disposition —•—13 Place of Disposition T►:�
Iv y Vt e— C e___
(address)
ILI
to
cc _ (section) (lot number)
(grave number)
ca Name of Sexton" P-rso . harge of Premises Ri11- _
ii _ z
(please print)
Signature .P- �"YI Title �a�. 'r 'L S'r
(over)
DOH-1555 (02/2004)