Ashline, Paula NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paula Ashline Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/10/2022 50 Years War or Dates
1.. Place of Death Hospital,Institution or
W City,Town or Village Saratoga Springs Street Address 27-0 S 187 Interstate Highway,Saratoga Springs,New York 12866
W Manner of Death ❑Natural Cause AccidentHomicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
G David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed city Of Saratoga Springs District Number Register Number
,Town orVill5e C' e 4501 168
Burial Date Cemetery,Crematory or Facility Name
Addre2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
Cl)❑Transportation Shipment
S by Common
Carrier Destination
Disinterment
Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
— Remains are Shipped,If Other than Above
5 Address
Q
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/14/2022 Registrar of Vital Statistics Ui/mMoran glectroncal(, ne4
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 31)S IZZ Place of Disposition J„..LL_ /✓i
2 (address)
W
N CC (section) /Lt (lot number/ (grave number)
8 Name of Sexton or Person in Charge of Premises L 1IT
lease print)
z
L✓ J�
III Signature Title r¢ 41194
DOH 1555(07/18)p 1 of 2
Y 5O
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#