Spiezio, Shirley A. 225
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Shirley A Spiezio Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/29/2020 81 Years War or Dates
Place of Death Hospital,Institution or
Z
City,Town or Village Saratoga Springs Street Address Saratoga Hospital
`p Manner of Death ❑X Natural Cause Accident Homicide Suicide Ei Undetermined Ei Pending
Circumstances Investigation
Q Medical Certifier Name Title
Derek Smith MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 619
Burial Date Cemetery,Crematory or Facility Name
12/03/2020 Pine View Crematory
Entombment Address
gCremation Queensbury Town,New York
['Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
U Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
2 Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/01/2020 Registrar of Vital Statistics join PaulTranck(IYectronicaf Signed)
(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
W Date of Disposition /Z�'] /Zo Place of Disposition
2 (address)
W
N
(section) alot number/ 3^ 11-1 (grave number)
0 Pre Name of Sexton or Person in Charge of ' es s•+
(p/eas�print/
W
Signature ��— Title l YW.«tfi tUrc-
�� S'
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) 014267
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#