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Loughney, Monica NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First,.onica Middle Francis LLoughney Sex Female Date of Death Age If Veteran of U.S. Armed Forces, 12/18/2013 98 years War or Dates Fr! Place of Death Hospital, Institution or Z City, Tg*Kgr)fir 4 1( Saratoga Springs Street Address Wesley Health Care Center . Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined ❑Pending US Circumstances Investigation W Medical Certifier Name Title 44. Austin Tsai M D Ad eis5sawrence St, Saratoga Springs, N Y Death Certificate Filed District Number Register Number City, TXJ&XArMAP Saratoga Springs 4501 523 ['Burial Date Cemetery or Crematory 12/20/2013 Pine View Crematory ['Entombment Address Cremation Queensbury N Y Date Place Removed Removal and/or Held and/or �; I—I Address In O Date Point of tL0 Transportation Shipment El by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Renterment 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 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address tr. II C Permission is hereby granted to dispose of the human rem . cr" ed a� indicat . iid Date Issued 12/20/2013 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: k ILI Date of Disposition Id I3)1' Place of Disposition ZU"-/- C4-c'',f•, 2 (address) IEEE Lai IC (section) (lot numbere (grave number) DName of Sexton or Pers in Charge f Premises Stitt-, -\r'^"wz. (pse print) Signature Title C-iTart. (over) DOH-1555 (02/2004)