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Metcalft, Maureen Eileen • NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Maureen Eileen Metcalfe Female Date of Death Age If Veteran of U.S.Armed Forces, 01/01/2021 75 Years War or Dates 1- Place of Death Hospital,Institution or Zr City,Town or Village Saratoga Springs Street Address Saratoga Hospital UJ a Manner of Death ©Natural Cause ❑Accident 1=1 Homicide ❑Suicide ❑Undetermined ❑Pending VCircumstances Investigation W Medical Certifier Name Title a Aaron Willen DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 1 ElBurial Date Cemetery,Crematory or Facility Name 01/06/2021 Pine View Crematory ElEntombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held H Hold Address (0 0 Date Point of t!)❑Transportation Shipment ES by Common Carrier Destination Date Cemetery Address ❑Disinterment 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 1 Remains are Shipped,If Other than Above S Address tr W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/04/2021 Registrar of Vital Statistics John Paul Pranck(E(ectronica((ySigned) (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: W Date of Disposition I h 1 Z l Place of Disposition -?�. /IL 2 (address) W CO (section) (lot number) (grave number) g Name of Sexton or Person in Charge of mises Ck't `" L c ^l/li (please print ( W Signature Title ` �`ft DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) - ) .1.4 3 9,5 Receipt Human remains of i ; delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# _ i