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Wall, Martin G.
303 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Martin G.Wall Male Date of Death Age If Veteran of U.S.Armed Forces, 12/02/2019 74 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital 'p Mannerof Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending V Circumstances Investigation WC Medical Certifier Name Title Bert Pyle MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Vill a Saratoga Springs 4501 1645 ❑Burial Date Cemetery,Crematory or Facility Name 12/04/2019 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held i- Hold Address iJf O IL Date Point of W ❑Transportation by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/03/2019 Registrar of Vital Statistics 9ofin Paul(Tranck(Efectronicadly Signed) (signature/ District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: p� Date of Disposition i S Place of Disposition U,,,i ( r� (address) W N cc /section/ (lot number) (grave number) a Name of Sexton or Person in Charge of Premises •�" t 4d Z / se print) W Signature Title &—yoR DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 01312 Receipt Human remains of delivered on , 20 Pine view Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#