Henninger, Mary .4.( # LIT?
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vitat Records
Name First Middle Last Sex
Mary Henninger Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/07/2023 69 Years War or Dates
t•— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W
pManner of Death n Natural Cause Accident Homicide []Suicide []Undetermined ❑Pending
U I ' "Circumstances. Investigation
W Medical Certifier Name Title
Ca Santosh Vaghela 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 IllBurial Date Cemetery,Crematory or Facility Name
06/08/2023 Pineview Crematory
Entombment Address
[]Cremation Queensbury,New York
IliDonation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
U)[]Transportation
p by Common Shipment
Carrier Destination
[]Disinterment
Date Cemetery Address
[]Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home William J Burke&Sons Funeral Home 01827
Address
628 N Broadway,Saratoga Springs, New York 12866
Name of Funeral Firm Making Disposition or to Whom
F— 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 06/07/2023 Registrar of Vital Statistics rDillon Moran(ilectronicalySrgn4
(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:
--' /2
Z Date of Disposition (!I i 113 Place of Disposition -r,,,w�. 4.J�'�-...
11.1
2 (address)
W
U)
♦C (section) (tot number) (grave number)
0 Name of Sexton or Person in Charge of P ises t< vH'�
Z
(pl se print)
lJJ Signature Title
l��rniipc
DOH-1555(07/18)p 1 of 2
1 - . .
Public Health Law Sec. 4145(2b)
Receipt
Human remains of , A ;T , r {`f_ delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# - '