Ashline, Doris H. 4 ,i- 2 I q
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Doris H.Ashline Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/23/2021 86 Years War or Dates
l.. Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death ❑X Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined 0 Pending
ILI
0 Circumstances Investigation
0 Medical Certifier Name Title
Stephen Offord MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 169
0 Burial Date Cemetery,Crematory or Facility Name
02/25/2021 Pine View Crematory
Entombment Address
ICremation Queensbury Town,New York
❑Donation
0 ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment 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 02/25/2021 Registrar of Vital Statistics join Pauf ranck(rElectronicaQ 4ne4
(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 permi on:
F—
W Date of Disposition 2I7i0 'Z( Place of Disposition 0(�
2 �"(address)
W
CC (section) 4 (lot number) (grave number)
c, Name of Sexton or Person in Charge of Premises /.• Lw4b�
Z (pse print)
IllSignature ���' Title riflArAiliN
DOH-1555(07/t8)p 1 of 2
Public Health Law Sec. 4145(2b) •J 1458 t
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home nameti'on burial permit
Official Funeral Directors Reg.or License#