O'Keeffe, Maureen NEW YORK STATE DEPARTMENT OF HEALTH JL'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Maureen Margaret O'Keeffe Female
Date of Death Age If Veteran of U.S. Armed Forces,
09/04/2012 78 years War or Dates
} Place of Death Hospital, Institution or
City, To XXXXV CX KX Saratoga Springs Street AddressILI Saratoga Hospital
c1 Manner of Death❑,AJatural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
t Circumstances Investigation
ul Medical Certifier Name Title
>E1 Bert Pyle M D
Address
211 Church St Saratoga Springs N Y
Death Certificate Filed District Number Register Number
City, To X 4KVXlX CX Saratoga Springs 4501 393
;><['Burial Date Cemetery or Crematory
09/06/2012 Pineview Crematorium
i ❑Entombment Address
Ei Qcremation Queensbury N Y
Date Place Removed
Z Removal and/or Held
2❑and/or Address
~ Hold
in
O Date Point of
t0 Transportation Shipment
a 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
IDI Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
ll
tt
tt Permission is hereby granted to dispose of the human remai e ri d ab a 'ndicate .
iiiiil Date Issued 09/06/2012 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:
,A
ttf Date of Disposition f�-- -/Z Place of Disposition P i[_. V G ,4 74 /
2 (address)Ui
7
to
ilk (section) (lot number) (grave number)
Iti Name of Sexto o Pe in Charge of Premises a
Z (please print)
l Signatur CZ Title eu- 4 -'r )45-S
(over)
DOH-1555 (02/2004)