Baker,Barbara Roosa Hz' c
NEW YORK STATE DEPARTMENT OF HEALTH g w Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Roosa Baker Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2020 88 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
WIL Manner of Death El
Natural Cause Accident El Homicide Suicide El Undetermined El Pending
✓ Circumstances Investigation
WD Medical Certifier Name Title
Sergio Lema-Gutierrez MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 636
❑Burial Date Cemetery,Crematory or Facility Name
12/08/2020 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
0
4. Date Point of
N ❑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
Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/08/2020 Registrar of Vital Statistics Join rPaulFranckglectrontiaili ISOte49
(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 1211 i'Zp Place of Disposition
2 (address)
W
CC
CC (section) flot number) (grave number)
0 Name of Sexton or Person in Charge of Premis r•. 1. � �
L �` (Pteaseiirint)
lL Signature L Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) A 9 1 1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#