Veneruso, Antoinette L. 11110
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Antoinette L.Veneruso Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/20/2020 65 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death ❑X Natural Cause ❑Accident 111 Homicide ❑Suicide Undetermined Ill Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 537
Burial Date Cemetery,Crematory or Facility Name
10/22/2020 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
t— Hold Address
0
d Date Point of
U) 1-1
Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
.g Address
CC
LLI
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/22/2020 Registrar of Vital Statistics JOIN Pau!FrauckgYectrnnica(Srgned)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W3• Date of Disposition /0!2170 Place of Disposition
2 (address)
W
CC (section) (lot ber) (grave number)
t
a Name of Sexton or Person in Charge of Prem. es 5 ��+
Z (please prin ��
▪ Signature Title ` 1"�►
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 0141 3 q
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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