King, Kathryn Margaret ll hl9H
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kathryn Margaret King Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2020 63 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Wilton Town Street Address 19 Hudson Avenue,Wilton Town,New York 12866
`p Manner of Death ❑X Natural Cause Accident ❑Homicide ❑Suicide Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
CI John Mongan DO
Address
3 Care Lane,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 49
Burial Date Cemetery,Crematory or Facility Name
11/10/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
ElDonation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
CL Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
El
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
f— Remains are Shipped,If Other than Above
Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/10/2020 _ Registrar of Vital Statistics Swan Balc1unn(EkctronicaQ Signer!)
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ��/��i 10 Place of Disposition IL
2 (address)
W
CC (section) (lot} number)
� (grave number)
O Name of Sexton or Person in Charge of Pre ' es r ° ' 4I1+1
Z
(pt se print)
Signature Title ` 41'Y-
DOH-1555(o7/18)p t of 2
i
Public Health Law Sec. 4145(2b) _ ® _ - �'
Receipt
Human remains of , delivered on , 20
Pine View Cemetery Representing the funeral home named 9n burial permit
Official Funeral Directors Reg.or License# , ,' {