Fueston, Margaret Mary NEW YORK STATE DEPARTMENT OF HEALTH (LID
Bureau of Vital Records 1"-- ' # --) g 7
Burial - Transit Permit
Name First Middle Last Sex
Margaret Mary Fueston Female
Date of Death Age If Veteran of U.S.Armed Fortes,
10/02/2022 75 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W Manner of Death Undetermined Pending
W Ei Natural Cause Accident EI Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
CI Sidharth Jogani MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 578
Burial Date Cemetery,Crematory or Facility Name
10/03/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
0❑Removal Date Place Removed
and/or and/or Field
H Hold Address
N
0
Q. Date Point of
Cl)❑Transportation
Q by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500,Lake Luzerne,New York 12846
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
g Address
Q
uJ
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/03/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(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:
~ -F lL 6 Z Date of Disposition �C�y �Z Z Place of Disposition ��
ILI (address)
W
NCC (section) `1 (lot numbeS,v4 (grave number)
0ft
Name of Sexton or Person in Char - Premises r'
Z lease print/
W Signature Title (V64�(-Ore
DOH-1555(07/18)pi of 2
p
Public Health Law Sec. 4145(2b) _.
Receipt
Human remains of 3 ` • delivered on • , 20 _.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#