Graham, RaymondN EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last
Sex
Raymond Foster Graham
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/19/2019
68 Years
War or Dates 1970-1971
Place of Death Hospital, Institution or
Z
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Uj
Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
El
13
li
Circumstances Investigation
U
W
Medical Certifier Name Title
Todd Duthaler DO
Address
211 Church St, Saratoga Springs, New York 12866
Death Certificate Filed
District Number
Register Number
City, Town orVillage Saratoga Springs
4501
495
Burial
Date
Cemetery, Crematory or Facility Name
Entombment
09/23/2019
Pine View Crematory
Address
aCremation
Queensbury Town, New York
Donation
z
Removal
Date
Place Removed
and/or
and/or Held
Address
f-
Hold
N
O
d.
N
Transportation
Date
Point of
by Common
Shipment
Destination
Carrier
❑ Disinterment
Date
Cemetery Address
Reinterment
7ie
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home M B Kilmer Funeral Home - Argyle
01077
Address
123 Main St, Argyle, New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W
a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2019 Registrar of Vital Statistics lt�Irn1'uulFi�znc(jElcctrt�niwlly,Si�n.r�
(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:
F—
Z
Date of Disposition Place of Disposition
uJ
2
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(a ddres5l
W
N
ti
(sedan) (lot number/ (gra ve number)
S
Name of Sexton or Person in Charge of Premises "
Z
/p! se print/
W
Signature AZ Title ita
DOH-1555 (07/18) p tot 2
Public Health Law Sec. 4145(2b)
012551
Receipt
Ii remains of
Pine View Cemetery
Official
delivered on t , 20 - t
Representing tie funeral home named on burial permit
Funeral Directors Reg. or License #