Petrie, Marie A , „ 4. ,
( L , 1
F .11- 77-)
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Marie A.Petrie Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2022 78 Years War or Dates
F- Place of Death Hospital,Institution or
Z City,Town or Village Wilton Town Street Address 60 Gailor Road,Wilton Town,New York 12831
ILI
Manner of Death ❑X Natural Cause nAccident Eln
Homicide Suicide Undetermined Pending
V0 f 1Circumstances Investigation
W Medical Certifier Name Title
0 John Delmonte MD
Address
3 Care Lane 300,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Wilton District Number Register Number
City,Town or Village 4569 75
Burial Date Cemetery,Crematory or Facility Name
11/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
Z Removal Date Place Removed
❑and/or and/or Held
~ Hold Address
N
0
0- Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
❑Reinterment
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
li— Remains are Shipped,If Other than Above
Address
CC
Ui
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/08/2022 Registrar of Vital Statistics Susan Baldwin gkctronicall:y Stgne4
(signature)
District Number 4569 PldCe Town Of Wilton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F- �
Z Date of Disposition 11 I Q I?Z Place of Disposition 'f,.A(L 4 -
2 (address)
Ill
Cl)ix (section) i (lot number) (grave number)
6
0 Name of Sexton or Person in Charge Premises hi (s-- ry
Z d7 (piase print)
IL Signature Title [tzl'Aap(
DOH-1555(07/18)p 1 of 2
P _. G 3 8 6
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#