Harvey, Pamela Anne NEW YORK STATE DEPARTMENT OF HEALTH ' Burial - Transit Per it
Bureau of Vital Records
Name First Middle Last Sex
Pamela Anne Harvey Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/17/2023 76 Years War or Dates
Place of Death P$ospitaL Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
pManner of Death EI Natural Cause ❑Accident Homicide Suicide nUndetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
Numan Rashid 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 52
Burial Date Cemetery,Crematory or Facility Name
01/19/2023 Pine View Crematory
Entombment Address •
aCremation Queensbury Town,New York
Donation •
8❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
a Date Point of
to ElTransportation Shipment
S by Common
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
L
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/19/2023 Registrar of Vital Statistics cDilton Moran(ECectronicalty 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:
Date of Disposition /-Zi Zo23 Place of Disposition �} `� iJ e v;e„J Cr ein h-M'r,5
ILI
2 (address)
W
NCC (section) (lot imbed (grave number)
g Name of Sexton or Person in Charge Pre ises ► ` ��'' 1� e'`' t
(please print)
W Signature f � Title
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#