Myers, Rita US7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rita Myers Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/21/2020 86 Years War or Dates
F. Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death D Natural Cause Accident Homicide 1=1 Suicide ❑Undetermined ❑Pending
U Circumstances Investigation
WQ 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 542
Burial Date Cemetery,Crematory or Facility Name
10/24/2020 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
• Removal Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
(/) ❑Transportation
El Common Shipment
Carrier Destination
Disinterment 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
Remains are Shipped,If Other than Above
Address
CC
Ui
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/26/2020 Registrar of Vital Statistics join 4'aulFranck(tE/ctronicafSigner!)
(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 o •
WH �
Date of Disposition II)I Zip/'0 Place of Disposition
2 (address)
W
CC (section) 7 ({lot number) (grave number)
Name of Sexton or Person in Char f Premises ` r'' L Mihj
(p ase print)
W Signature Title /f*"treC
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) ` - I t 7
Receipt
Human remains of delivered on ` , 20
' • 4 '
Pine View Cemetery Representing the funeral home named on bial permit
Official Funeral Directors Reg.or License# -