Arnold, Elsie NEW YORK STATE DEPARTMENT OF HEALTH `7
Vital Records Section Burial - Transit Permit
Name Firgsie MiddleMarcella Li rnold SexFemale
Date of Death Age If Veteran of U.S. Armed Forces,
10/21/2013 86 years War or Dates
Place of Death Hospital, Institution or
City, T�4>a4XXrXi Saratoga Springs Street Address Saratoga Hospital (NH)
0 Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
tii Circumstances Investigation
tu Medical Certifier Name Title
P. Stephen Fishel M. D.
A d 6 F$egica! Park Drive, Suite 205, Malta N Y
Death Certificate Filed District Number Register Number
City, TAX,MMIAM Saratoga Springs 4501 424
❑Burial Date Cemetery or Crematory
10/23/2013 Pineview Crematorium
0 Entombment Address
Cremation Queensbury N Y
Date Place Removed
2❑Removal and/or Held
42 and/or H Hold Address
i
0 Date Point of
0' Trans ortation
❑ p Shipment
G3 by Common Destination
Carrier
Ei!i0 Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
K. Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
`> Address
402 Maple Avenue, Saratoga Springs, N Y 12866
Ni Name of Funeral Firm Making Disposition or to Whom
1.4 Remains are Shipped, If Other than Above
;; Address
t
111
IX
. Permission is hereby granted to dispose of the human rema- cri d abve indicate .
Date Issued 10/22/2013 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:
t
lit Date of Disposition 10(Z3113 Place of Disposition ?Zit., �'r ta,��...
(address)
Ili
CC (section
)) _ (lot nu`'�r) (grave number)
Ci Name of Sexton or Person i harge of Pr ises u il J twii
(please print)
;_:: Signature L Title CriE
lvinr
(over)
DOH-1555 (02/2004)