Savelis, Alfred4FCIO
N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last
Sex
I
Alfred Savelis
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
10/07/2019
97 Years
War or Dates 1942-45
C~
Place of Death Hospital, Institution or
WCity,
Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
a
Mannerof Death � Natural Cause ❑ Accident � Homicide � Suicide � Undetermined � Pending
C.)Circumstances
Investigation
W
Medical Certifier Name Title
G
Thomas Kandora MD
Address
319 Broadway, Fort Edward Town, New York 12828
Death Certificate Filed
District Number
Register Number
City,Town orVillage Fort Edward
5755
80
Burial
Date
Cemetery, Crematory or Facility Name
Entombment
10/08/2019
Pine View Crematory
Address
Cremation
Queensbury Town, New York
Donation
Removal
Date
Place Removed
OZ
and/or
and/or Held
Address
P
Hold
N
O
Q.
Date
Point of
N
p
Transportation
by Common
Shipment
Destination
Carrier
❑ Disinterment
Date
Cemetery Address
Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home M B Kilmer Funeral Home -Fort Edward
01079
Address
82 Broadway, Fort Edward, New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Q
W
a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/08/2019 Registrar of Vita I Statistics f7imre;�lalu�nry(6lectmnicaYy,!iV-l%
/signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
WDate
of Disposition 10 rj (� Place of Disposition ,✓ Cw.—
uj
/address/
W
N
/section) /lotnumber/ /grave number/
SName
of Sexton or Person in Charge of Premises a'.
Z
/ease p
W
Signature Title
DOH-1555 (07A8) p t of 2
Public Health Law Sec. 4145(2b)
012585
Receipt
Human remains of delivered on ,� ! c , 20
Pine View Cemetery Representing the funeral ho a names Agnn b .}a"t
Official Funeral Directors Reg. or License # _