Hernandez-Casumiro, Rosemary NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rosemary Hernandez-Casimiro Female
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 01 / 2021 0 War or Dates N/A
}- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address
iij Saratoga Hospital
0 Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Catelyn Halusic-Smith MD
Address
59 Myrtle St., Ste 100, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs ]1 "
Burial Date Cemetery or Crematory
01 / 06/ 2021 Pine View Crematory
i:i 8 Entombment Address
ECremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
Hold
ODate Point of
Q Transportation Shipment
a by Common Destination
Carrier
' '�Q Disinterment Date Cemetery Address
€.::,:�
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
°` ; Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Arm Making Disposition or to Whom
4 Remains are Shipped, If Other than Above
Address
F
Permission is hereby granted to dispose of the human re scri d abov as indicated.
Date Issued /' Registrar of Vital Statistics
(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
Lu Date of Disposition J-//-Zc1 Z5/ Place of Disposition nl e—t>i (r0441-cie/
(addresk)
lAt
W.
CC (section) 1 /• (lot number) (grave number)
tiName of Sexto r P rson ip Charge of Premises �_Ji,,11 v1 (9G rtG
Z'•. (please print)
iiii
Signature Title G.r mcery 11�L�u��/
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) 1 t °
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named/on,l rjal permit
Official Funeral Directors Reg.or License# '