Moran, Jessie Colleen •
NEW YORK STATE DEPARTMENT OF H EALTH Burial- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jessie Colleen Moran Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/22/2021 42 Years War or Dates
F. Place of Death Hospital,Institution or
W City,Town or Village Milton Town Street Address 184 Saratoga Avenue,Milton Town,New York 12020
1p Manner of Death ❑Natural Cause ElAccident ❑Homicide Ei Suicide ElUndetermined ❑X Pending
Circumstances Investigation
W Medical Certifier Name Title
O Robert Ball Coroner
Address
10 Glen Eagles Blvd,Ballston Lake,New York 12019
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 07
❑Burial Date Cemetery,Crematory or Facility Name
01/26/2021 Pine View Crematory
❑Entombment Address •
▪Cremation Queensbury Town,New York
▪ Donation
0❑Removal Date Place Removed
and/or and/or Held
Hold Address
O
O. Date Point of
rn❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment 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
H Remains are Shipped,If Other than Above
5 Address
CC
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/26/2021 Registrar of Vital Statistics Brerrrla?lowealecemnica*Signe%
(signature)
District Number 4561 Place Ballston Spa, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit
p ,U
W Date of Disposition Z71 ZI Place of Disposition tz
adorress)
IL
CC N
(section) (lot prber) (grave number)
O Name of Sexton or Person in Charge of P ses �j r`p�� /M/N�`�
Z (please print) / 9
I111 Signature Title � "4W
DOH-1555(07/18)p 1 of 2
• r
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of delivered on - , 20 •
i
Pine View Cemetery Representing the funeral home named on burial,permit
Official Funeral Directors Reg.or License# i