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Butler, Martha Ann
6 It zy� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records " Name First Middle Last Sex Martha Ann Butler Female :, Date of Death Age If Veteran of U.S.Armed Forces, `_ 03/13/2023 75 Years War or Dates i;:, Place of Death ....lzhaigiMenstitution or Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc W' Manner of Death Z Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Q Medical Certifier Name Title 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 172 Burial__. Date Cemetery,Crematory or Facility Name 03/16/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,Tewn,New York Donation - Z Date Place Removed O❑Removal and/or Held p: and/or N Hold Address 0 CL Date Point of (/)oTransportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped,If Other than Above _ _ Address CC W ---- n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/16/2023 Registrar of Vital Statistics Aron 9l,foran(E(ectronicallySigned) (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- / Z Date of Disposition 3)11 115 Place of Disposition --Y4,� �jf"v---_ LU 2 (address) W NCC (section) X (lot number) (grave number) i 0' Name of Sexton or Person in Charge of Prem. '1/4- 1T t Z qease print) MISignature Title ( 4T30 DOH-1555(07/18)p 1 of 2 016798 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#