Griesmar, Claudia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
`c:;; Name First Middle Last Sex
Claudia Griesmar Female
Date of Death Age If Veteran of U.S. Armed Forces,
x"= 06/10/2018 73 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ri❑Pending
Circumstances Investigation
Medical Certifier Name Title
Jacqueline Smith DO
Address
211 Church St,Saratoga Springs,New York 12866
'; Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 327
>'❑Burial Date Cemetery or Crematory
06/12/2018 Pine View Crematory
'❑Entombment
��� Address
J ®Cremation Queensbury Town, New York
Date Place Removed
gri❑Removal and/or Held
In and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
;- Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
•
'4 Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tti
Permission is hereby granted to dispose of the human remains described above as indicated.
- Date Issued 06/12/2018 Registrar of Vital Statistics John P'Franck(Etectronica((ySigned)
(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:
Date of Disposition 6IIS id Place of Disposition T'kta--/ ( tor..
(address)
(section) /dot number) (grave number)
Name of Sexton or Person in Charge of Premises u1 U- �41t0
//' (pl&se print)
Signature ‘41 /L�— Title I fMtt7.4�`'�
(over)
DOH-1555 (02/2004)
1