Johnsen, Sterling Lawrence NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sterling Lawrence Johnsen Male
Date of Death �Age If Veteran of U.S.Armed Forces,
04/30/2020 War or Dates 1958-1985
F— Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death ❑X Natural Cause ❑Accident Homicide ❑Suicide Undetermined Pending
W Circumstances Investigation
U
Uj Medical Certifier Name Title
Sergio Lema-Gutierrez MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 1260
Burial Date Cemetery,Crematory or Facility Name
05/02/2020 Pine View Crematory
Entombment Address
1 Cremation Queensbury Town,New York
❑Donation
❑Removal Date Place Removed
and/or and/or Held
l-N Hold Address
0
d Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
joReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
Address
ir
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/01/2020 Registrar of Vital Statistics ,74,71'aulFranck(E&troaicaf Srguerl�
(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:
W Date of Disposition SI Z I26 Place of Disposition !K ()(w-
2 (address/
W
CO) (section) lot number/ (grave number/
23 Name of Sexton or Person in Charge of Premises " 1 ' B,.A4h
Z (PlealileprinO /
W Signature _� Title
DOH-1555(07/18)p 1 of 2
d`
1 Public Health Law Sec. 4145(2b) � J.3 r)g S
1
Receipt
Human remains of delivered on , 20 'j
Fine View Cemetery, R6presenting the funeral home named,A burial permit
Official Funeral Directors Reg.or License#
1