Wilson. Helen D r� s7
NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Helen D.Wilson Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/25/2020 87 Years War or Dates
.. Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
W
Manner of Death ❑X Natural Cause Accident Homicide ❑Suicide Undetermined 11 Pending
Circumstances Investigation
W Medical Certifier Name Title
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 691
0 Burial Date Cemetery,Crematory or Facility Name
12/29/2020 Pine View Crematory
0 Entombment Address
Cremation Queensbury Town,New York
ElDonation
IS Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d 1-1 Date Point of
U) ❑Transportation
El Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/29/2020 Registrar of Vital Statistics join Q'au!T'ranckgkaronica(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:
H
Z Date of Disposition 12-; . zoZU Place of Disposition )111
2 (address)
Lii
CC CC (section) lot number) (grave number)
0 ci Name of Sexton or Person in Charge of Premises -l k 1 ►�►�e tr,-7 G' 4
(please print)
Z , /
W Signature Ad.. / Title G fQ✓''► a-4r// �afP/e�9`e,'"--
DOH-1555(o7/18)p t t 2
8
Public Health Law Sec. 4145(2b) (" 1 c
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named opkburial permit
Official Funeral Directors Reg.or License#