Mathes, Maria Anna 3)6
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Maria Anna Mathes Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/20/2020 93 Years War or Dates
.._ Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death 0 Natural Cause Accident Homicide Suicide ❑Undetermined n Pending
W Circumstances Investigation
al Medical Certifier Name Title
CI Kimberly Fiscella
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 P799
Burial Date Cemetery,Crematory or Facility Name
12/23/2020 Pine View Crematory
Entombment Address
QCremation Queensbury Town,New York
❑Donation
ZRemoval Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
U) ❑Transportation
8 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
F 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 12/22/2020 Registrar of Vital Statistics Dania?Scil.)*(E/ctronicall:y Srgned)
(signature)
District Number 0101 Place Albany, 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 /2.2i/—Zc�41 Place of Disposition 1 'z z vi t°►,� �,!2?rt 9�!
2 (addres/
W
U)
CC (section) (lot number) (grave number)
• Name of Sexton or Perso Charge of Premises `�� /r c C4.i i e_
Z ! (please print) —
tJV Signature ,/\� Title /L mom'?/, O�C ,Js�
DOH-1555(07/18)p of 2
Public Health Law Sec. 4l45(2b) ;�
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#