Maham, Ida rw` C
NEWYORKSTATEDEPARTMENTOFHEALTH dr ", Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ida Mahan Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/20/2021 63 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Ulster Town Street Address Northeast Center For Special Care
p• Manner of Death ❑X Natural Cause El AccidentHomicide Suicide Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
Steven Ritter MD
Address
300 Grant Ave,Lake Katrine Hamlet,New York 12449
Death Certificate Filed District Number Register Number
City,Town or Village Ulster Town 5567 8
ElBurial Date Cemetery,Crematory or Facility Name
01/21/2021 Pine View Crematory
11 Entombment Address
EiCremation Queensbury Town,New York
❑Donation
g ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
0
d Date Point of
W 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
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/21/2021 Registrar of Vital Statistics Suzanne Lathe jarygkctronicaf Signed)
(signature)
District Number 5567 Place Ulster Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZDate of Disposition j I ZZ J7j Place of Disposition
2 ' (address)
W
CC
N (section) d (lot numb (grave number)
F/
g Name of Sexton or Person in Charge f Premises 1 rA 1,4tt
Z
(pleate print)
W Signature Title
DOH-1555(07/18)p i of 2
•
Public Health Law Sec. 4145(2b) , 144 IL 9
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#