Gardner, Charlotte Mae (z
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Charlotte Mae Gardner Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/11/2021 77 Years War or Dates
1_ Place of Death Hospital,Institution or
Z City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
W
p Manner of Death Natural Cause 0 Accident Homicide ID Suicide Undetermined El
Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
CI Leonard Gelman MD
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville Village 5725 4
❑Burial Date Cemetery,Crematory or Facility Name
01/13/2021 Pine View Crematory
❑Entombment Address
lCremation Queensbury Town,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
H
N Hold Address
0
0- Date Point of
co ❑Transportation
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
uJ
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/12/2021 Registrar of Vital Statistics RFe1anl1696ertrgfctronrca�ySOned)
(signature)
District Number 5725 Place Granville Village, 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 1/l3)Li Place of Disposition
2 (address)
W
CC CC (section) (lot number) (grave number)
ca Name of Sexton or Person in Charge of emises �l A( ease print)
%, ,�7��
W Signature Title '�"�''N'rrt'�
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 014406
Receipt
Human remains of ' °' ` ' ` ,;( delivered on r i , 20
t !f h„�•
.1•� .!� if ` � - a
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#