Abraham, Donna r
NEW YORK STATE DEPARTMENT OF HEALTH ! i 3��
Vital Records Section
Burial - Transit Perm
Name First Middle Last Sex
Donna Eleanor Abraham Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/12/2013 • 78 years War or Dates
}. Place of Death Hospital, Institution or
W City, Towrgfrill XX Glens Falls Street Address The Pines
a Manner of Death Nptural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined ❑Pending
4 Circumstances Investigation
W Medical Certifier Name Title
o William Parker Physician
Address
88 Broad Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, TowrX II XX Glens Falls 5601 250
❑Burial Date Cemetery or CrematoryEntombment 06/17/2013 Pine View Cemetery
Address .
L Cremation Queensbury, NY 12804 •
[—Date Place Removed
Z❑Removal and/or Held
and/or Address
•" Hold
CO
O Date Point of
frti❑Transportation Shipment
Et by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care • 00364
Address
402 Maple Street Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Imo:- Remains are Shipped, If Other than Above
;" Address
la
fl` Permission is hereby granted to dispose of the humarremain escribed bove as i c ed.
Date Issued 06/13/2013 Registrar of Vital Statistics . r—e-€41 / ?IL-C._,
J7�
(signature]
District Number 5601 Place Glens Falls
•"" I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition 4,-r)-t3 Place of Disposition . e.,. �n.) tc't6(i
2 (address)
L
CC (section) lot number) (grave number)
Name of Sexton or Person in Charge of Premises `4r=it4►1 c�f e"~
it
2 (plea a print)
l<:tl Signature Title W11�i it
(over)
DOH-1555 (02/2004)'
N,