Weller,Yvonne , ...
01 F A Licit,
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Yvonne Weller Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/30/2022 85 Years War or Dates
p.. Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
ILI
p Manner of Death ❑X Natural Cause Accident Homicide Suicide FlUndetermined in Pending
W
U Circumstances I 'Investigation
W Medical Certifier Name Title
O Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 338
Burial Date Cemetery,Crematory or Facility Name
® 06/01/2022 Pine View Crematory
Entombment
_ Address
nCremation Queensbury Town,New York
Donation
Date Place Removed
0❑Removal and/or Held
F and/or
N Hold Address
0
d Date Point of
U)❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
N Address
CC
LU
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/01/2022 Registrar of Vital Statistics Dillon 9.loran(ECectronicaCCySigned)
(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:
I— I/ elf-
Z Date of Disposition L'I Z 1 M Place of Disposition
i,tU ✓t" —�
2 (a dress
W
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises r�!e e riot) Sobvi•-k
t
Zii)/ (P P
11J lakel
Signature Title L �
DOH-1555(07/18)p 1 of 2
ot
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#