Cooper, Sharon qi
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sharon Lee Cooper Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/05/0013 67 years War or Dates
I- Place of Death Hospital, Institution or
WCity, T? Saratoga rings Street Address Saratoga Hospital
W �-�Manner of Death t, Natural Cause Accident ❑Homicide ❑Suicide ElUndetermined ri❑Pending
Circumstances Investigation
W Medical Certifier Name Title
CI RPnPe Rodriguez Goodemote M D
Address
211 Church Street, Saratoga Springs, New York 1286
Death Certificate Filed District Number Register Number
City, "intop.4wivziwivwtiona4Saratoga Springs 4501 10
ID Burial Date Cemetery or Crematory
❑Entombment 01/07/2013 Pineview Crematorium
Address
,]Cremation Queensbury N Y
Date Place Removed
Z ❑Removal and/or Held
2 and/or Address
E=` Hold
fa
O Date Point of
ta Li
Transportation Shipment
G by Common Destination
Carrier
❑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
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
tr
ILI
I Permission is hereby granted to dispose of the human remai ib abor,a ' dicated
Date Issued 01/07/2013 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:
ta Date of Disposition / '`3 Place of Disposition Pv11 -(J j. C_Ali
(address)
ta
co
lc (section) (lot umber) (grave number)
o Name of Sexton r in Charge of Premises �JL�d g14Y1
2 (please&
ill Signature / Title 0/ /7)/443‘._-.
(over)
DOH-1555 (02/2004)