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Ashdown, Bradford NEW YORK STATE DEPARTMENT OF HEALTH it__ ,, ,Vital Records Section Burial - Transit Permit Name First Middle Last Sex Bradford Reed Ashdown Male Date of Death Age If Veteran of U.S.Armed Forces, _May 20,2006 56 War or Dates Vietnam Place of Death Hospital, Institution or j_ City of Saratoga Springs Saratoga Hospital&Nursing Home Z City,Town or Village Street Address W Manner of Death Q Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending CI Circumstances Investigation LU 0 Medical Certifier Name Title N! Rodney Ying MD 0 Address 59 Myrtle Ave.,Saratoga Springs,NY Death Certificate Filed District Number Registy{Numb br City,Town or Village Saratoga Springs 4501 C, ® ti El Burial Date Cemetery or Crematory 5/22/2006 Pine View Crematory ❑ Entombment Address © Cremation Queensbury,NY Date Place Removed z ❑ Removal and/or Held p and/or Address H Hold o Date Point of a ❑ Transportation Shipment N by Common Destination O Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00036 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped, If Other than Above g Address aPermission is hereby granted to dispose of the human remai c 'betel abo i a dicated.i i. Date Issued 5-22-06 Registrar of Vital Statistics t "� (signat re) District Number 4501 Place Saratoga Springs,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition (I 3(t;�:: Place of Disposition P il.d.:c— l i< Al-,," ;,,d s..." g (address) W V) (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises (- n S S I h rs-c IT Z /f2 (please print) W Signature �ltiA Title C ` .r r DOH-1555(02/2004) (over)