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Griffin, Colleen s t uo NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name Fitsotlleen Middle Ann Gnttin Seremale Date of Death Age If Veteran of U.S. Armed Forces, 04/07/2013 59 years War or Dates 1 Place of Death Hospital, Institution or Z City, UuMoKVAX0re Saratoga Springs Street Address Saratoga Hospital W Manner of Death Undetermined Pending ©Natural Cause �Accident �Homicide �Suicide � � Lt Circumstances Investigation iii Medical Certifier Name Title II Richard F. Duff I I I M D dre s ,. aratoga Hospital; Saratoga Springs, Ny 12866 a. Death Certificate Filed District Number Register Number City, �o?� r Saratoga Springs 4501 167 al['Burial Date Cemetery or Crematory 04/10/2013 Pine View Cemetery ❑Entombment Address CICremation Queensbury N Y . Date Place Removed Z Removal and/or Held 2❑and/or Address. i;; Hold to 0 Date Point of Q In Li Transportation • Shipment el by Common Destination gi Carrier El Disinterment Date Cemetery Address El Reinterment Date Cemetery Address imiai Permit Issued to Registration Number Name of Funeral Home Maynard D. Baker Funeral Home . 01130 Address 11 Lafayette Street, Queensbury, N Y ilill Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address Iii• ` Permission is hereby granted to dispose of the human re Xry.\3ed,aro s indic ed. iiiik Date issued 04/10/2013 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs Li I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ui• Date of Disposition 11'I1'l3 Place of Disposition `` a 6it.•l recioriJtt.- 2 (address) U i w CC (section) i (lot number) (grave number) ct Name of Sexton or Perso in Charge of P mises hr, �l'We 2: lease print) Signature Le. - Title °WM l'i-TO e_ ;;: (over) DOH-1555 (02/2004)