Elmer, Georgianne M. , t t (13
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Georgianne M.Elmer Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/10/2021 84 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 Undetermined 1=1Pending
W ❑X Natural Cause ❑Accident ❑Homicide Suicide
U 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
❑Burial Date Cemetery,Crematory or Facility Name
01/12/2021 Pine View Crematory
11 Entombment Address
O Cremation Queensbury Town,New York
EI Donation
ZZ Removal Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
(I) LI 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
F.- Remains are Shipped,If Other than Above
Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/12/2021 Registrar of Vital Statistics Join rPau19HranckgYectronica(Stgnea9
(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 f /13/2' Place of Disposition
address)
W
CC CC (section) (t j numb (grave number)
in Name of Sexton or Person in Charge of Pr .ses G t 2'"► �
in (pl ase print)u /J i Title ` �TWI
Signature
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) - 14 409
Receipt
Human remains of delivered on ' , 2O
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ;
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