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Wieland, Xenia V
"it 72C--- NEWYORKSTATEDEPARTMENTOFHEALTH Bureau of Vital Records BUrlal - Transit Permit Name First Middle Last Sex Xenia V.Wieland Female Date of Death Age If Veteran of U.S.Armed Forces, 09/04/2023 91 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 ID Natural Cause Accident Homicide 0Suicide Undetermined Pending Ili Circumstances Investigation 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 513 Burial Date Cemetery,Crematory or Facility Name 09/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation 2 Date Place Removed 0❑Removal and/or and/or Held H Hold Address CO Transportation Date Point of ' by Common Shipment Carrier Destination - ❑Disinterment Date Cemetery Address t b Reinterment Date Cemetery Address P Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address ;` 53 Quaker Rd,Queensbury,New York 12804 s: Name of Funeral Firm Making Disposition or to Whom Lsi Remains are Shipped,If Other than Above Address ir til C: Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/06/2023 Registrar of Vital Statistics nikm Moran gkctronica*Atnet (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 9 7aa-^ZQL3 Place of Disposition f`,..it' j./e0 Ci-i7 - , iu (address) 111,11 Q (section) (lot number (grave number) GName of Sexton or Person in Charge remises )'�t//J?o o it) 2 (please print) WSignature / g �iy� � Title Qi'J�-c�tUr(-- DO H-1555(o7/18)p 1 of 2 1 4 r 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#