Ettkin, Eileen It Z
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Eileen Ettkin Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/16/2020 88 Years War or Dates
F., Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death Natural Cause 0 Accident 0 Homicide ❑Suicide Undetermined Pending
VCircumstances Investigation
WD Medical Certifier Name Title
Rome!Gobunsuy MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 579
Burial Date Cemetery,Crematory or Facility Name
11/17/2020 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
11 Donation
ZO Removal Date Place Removed
and/or and/or Held
N Hold Address
0
1-1 Date Point of
Cl) ❑Transportation
p by 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
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/17/2020 Registrar of Vital Statistics join PaulrFranckgYectronicaQ Stgned)
(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:
Z Date of Disposition II I)g f Za Place of Disposition
2 „Rik(address)
W
CC (section) d (lot number) (grave number)
c
0 Name of Sexton or Person in Charge of emises l f ' \--
Z (pl se print)
Signature les Title
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) '3 1 4 0 7
Receipt
Human remains of '' delivered on . , , 20..
ril
Pine View Cemetery Representing the funeral home named on burial permit
•
Official Funeral Directors Reg.or License#