Reger, Jean Fay asarsm G.••.y
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jean Fay Reger Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/31/2022 87 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death
0 Natural Cause Accident Homicide OSuicide Undetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
0 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 787
X Burial Date Cemetery,Crematory or Facility Name
01/16/2023 Pine View Cemetery
_Entombment Address
Cremation Queensbury Town,New York
Donation
ZZ❑Removal Date Place Removed
and/or and/or Held
- Hold Address
to
0
O. Date Point of
(I) Transportation Shipment
p by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
EIReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
Address
IOC
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/05/2023 Registrar of Vital Statistics )Hilton Moran(ECectronica((ySigned)
(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:
Z
W Date of Disposition ,„) Place of Disposition L) \ (ajCA,\<<i_ 4.) C-31,teC=1>IL /V/
2 (address) I
Ui 3i F 9
cc (secto (lot number) (grave number)
G
Name of Sexton or Person in Charge of Premises �n�i e
(please prkel
W Signature ; Title LA .�iX nn�� �
DOH-1555{07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 012965
Receipt
Human remains of delivered on , 20
ne View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
RPgPY Lot No.3� .
Address 12 Willow Road OuPPnsbury, NY 1 7Rna Section No.
Owner PlorEr i e
Jean Roger
Vol,lyoketAl OVA
Date Nov. 26, 2013
67 Superficial ft. @
Location Bounded West Douros North Path, East Murphy, South Vacant
Corner Posts
Remarks 518-793-2859
Deed No. (and changes) 3835
Payment Record c 17 n n
Al(N .
Record of Interments
r2QJ 17o
George Reger Nov. 30. 2013
2 cAeca _N-Rcsei_ ' \Lo DD h)
3
1I
it
Form No. 01
REGER
NAME Jean Fay Reger ;' -.`," Age: 87
Lot Owner: Jean Reger
Lot# Erie 36F Grave# 2
Case: Concrete
Died: 1 2/31 /22 Interred:1 /1 6/23
Funeral Home: Carleton FH
Cemetery: Pine View