Sabia John M NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John M Sabia Male
Date of Death Age If Veteran of U.S.Armed Forces,
O2/20/2020 78 Years War or Dates 1961-1965
II.— Place of Death Hospital,Institution or
Z City,Town or Village Elizabethtown Town Street Address Elizabethtown Community Hospital
W
`p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Mary Halloran MD
Address
75 Park Street PO Box 277,Elizabethtown Town,New York 12932
Death Certificate Filed District Number Register Number
City,Town or Village Elizabethtown 1552 8
Burial Date Cemetery,Crematory or Facility Name
02/22/2020 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
(A
O
G. Date Point of
M Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition orto Whom
Remains are Shipped,If Otherthan Above
Address
Q
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/21/2020 Registrar of Vital Statistics Janet E Cross(ECectronicalTySigned)
(signature/
District Number 1552 Place Elizabethtown, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition of-aa-.ZOZG Place of Disposition ,J C rGy�1a
W
2 / ress/
W
N (section) (lot number) (grave number)
Q
0 Name of Sexton or Person in Charge of Premises '
Z /please print/
W Signature f Title O r
DO H-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 013358
Receipt
Human remains of delivered on , 20 i
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#