Vosburgh, Jeanette Putman Cates if it
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jeanette Putnam Cates Vosburgh Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/12/2021 91 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
W Manner of Death Ii Natural Cause Accident Homicide Suicide Liri Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
G 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 29
Burial Date Cemetery,Crematory or Facility Name
01/14/2021 Pine View Crematory
Entombment Address
ElCremation Queensbury Town,New York
Donation
gRemoval Date Place Removed
and/or and/or Held
F— Hold Address
N
0
O. Date Point of
Cl) 1-1
Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
l— Remains are Shipped,If Other than Above
Address
14!
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/13/2021 Registrar of Vital Statistics ,loin Paul Franck(Ekctronicalry Signed)
(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
Li! Date of Disposition /JN/21 Place of Disposition to
2 (address)
W
N CC (section)(section) A (lot number) (grave number)
ll��
C Name of Sexton or Person in Charge of Pr • s n' l�nbll�
Z (pletlse print)
W Signature ( r Title 101p"iF
Tpa
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b) 014112
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#