Jarett, Edyth A ` Dr'
g3 -7
r o+
NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edyth A.Jarett Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/19/2022 100 Years War or Dates 1945-1947
Il— Place of Death Hospital,Institution or
Z City,lown or Village Saratoga Springs Street Address Wesley Health Care Center Inc
SManner of Death El Natural Cause DAcci 0 Homicide ❑Suicide DU ndetermined ❑Pending
W Circumstances Investigation
0 W Medical Certifier Name Title
G Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed city Of Saratoga Sprite District Number Register Number
Cit ,1 own or Village 4501 B13
Burial Date Cemetery,Crematory or Facility Name
Addre2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York ,
aDonation
❑Removal Date Place Removed
and/or and/or Held
(A
Hold0
Address
Date Point of
%ClTransportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
pReinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01598
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
11— Remains are Shipped if Otherthan Above
2 Address
Q
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/21/2022 Registrar of Vital Statistics mrl)oa.9doran(rEGctronka j,SrgrrsdO
(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:
Date of Disposition je-21-74 1 Z Place of Disposition R ,p1 P iX e,,) (T P—a lc 1Th
W (adbess/
W
CC (sec►ion (lot number) /gre re number)
8 Name of Sexton or Person in Cha of Pre ' es A if Pries ', ,Wr 00 cl
Z
(Please print)
W Signature / !/ Title t 0 DOH 1555(07/18)p 1 of 2
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#