Saunders, George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George Mason Saunders Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/05/2008 78 years War or Dates Yes
} Place of Death Hospital, Institution or
Z City, Town vongalgXXX City Of Glens Falls Street Address Glens Falls Hospital
Uj
a Manner of Death r Undetermined Pending
a Natural Cause �Accident �Homicide �Suicide � �
W. Circumstances Investigation
ta Medical Certifier Name Title
Robert W. Sponzo M. D.
Add{B Spark Street Glens Falls, Ny 12801
Death Certificate Filed District Number Register Number
City, TownIaligXXX City Of Glens Falls 5801 813
❑Burial Date Cemetery or Crematory
12/05/2008 Pine View Crematorium
[Lntombment Address
14Cremation Queensbury, NY 12804
>::: Date Place Removed
Removal and/or Held
Q and/or
Address�
Hold
VI
0 Date Point of
ilk❑Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
A ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home - 01194
Address
11 Lafayette Street Queensbury, N Y 12804
11 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
;2 Address
ttt
97 Permission is hereby granted to dispose of the human remains described a _ove as indic ed
Date Issued 12/05/2006 Registrar of Vital Statistics OP--e
(signature)
District Number Z.0 ) Place 6j ,,S ,\S Q
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
tUU Date of Disposition i'it./vi Place of Disposition Pintiilr+� Crzmc.. -L,r1,,.,,,.
2 (address)
tilt
CO:
CC (section) (lot number) (grave number)
Name of Sexton or Person in C arge of Premises C r i s Senn, fir
z I (please print)
toSignature Lun Title Cam'*4-fc,(--
(over)
DOH-1555 (02/2004)