Cleveland, Aaron NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Perri' -
Name First Middle Last ,. x
Aaron Cleveland : old
iT r ,
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 27 / 2017 46 War or Dates, N/A
l- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address 286 try
� Manner of Death®Natural Cause El Accident 0 Homicide El Suicide ���� � = a ''
Cir !Il'ivr Lion
til Medical Certifier Name Title
a Roberta Miller MD r '
Address
16 Crimson Oak Ct, Schenectady; NY 12309
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 01 '7°
OBurial Date Cemetery or Crematory
07 / 28 / 2017 1 Pine VieW Crematory 4
;;;;; D Entombment Address
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
4
Hold
Date Point of
Q Transportation Shipment
L by Common Destination
Carrier
0 Disinterment Date Cemetery Address
iiiiiiiQ Renterment Date Cemetery Address
>` Permit Issued to Registration Number
iiM Name of Funeral Home Compassionate Funeral Care 00364
OF
Address
iti 402 Maple Ave. , Saratoga Sp. , NY 12866
[ Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
iIr
ilk
". Permission is h1i /f )
by anted to dispose of the human remain ibe above as indicated.
gn Date Issued Registrar of Vital Statistics �- ,,
(signature)
District Number tj 5-01 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7/3/>/7 Place of Disposition / /��; ‘Ie4.,-c4 .e y
/ l (address)
tai
IIE (section) (lot number) (grave number)
i Name of Sexton or P harge of Premises ___. _ ______________+^-/. it . vrs? 4:- 4.
Z (please print)
ILI
Signature Title G.0.-.Q.ram 44," _
(over)
DOH-1555 (02/2004)