Stiffen, George r
# YS 7_
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
,ol. Name First Middle Last Sex
ti George Thomas Stiffen Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/06/2018 80 Years War or Dates 1954-1962
Place of Death Hospital, Institution or
4; City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Mangier of Death gNatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
iii Medical Certifier Name Title
g James Corwin
MD
dv
Address
• 211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
• City, Town or Village Saratoga Springs 4501 315
0 Burial Date Cemetery or Crematory
06/07/2018 Pine View Crematory
• 0 Entombment Address
®Cremation Queensbury, New York
Date Place Removed
-• ❑Removal and/or Held
and/or
Address
Hold
Date Point of
- Transportation Shipment
by Common Destination
• Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Tunison Funeral Home 01730
c Address
105 Lake Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
6t Permission is hereby granted to dispose of the human remains described above as indicated.
'''' Date Issued 06/06/2018 Registrar of Vital Statistics John P Franck(Efectronica1TySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
d
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i` Date of Disposition G/') (ig Place of Disposition gt4d.../ rmor,l--
(address)
rr
p3
(section) lot number) (grave number)
Name of Sexton or Person in Char a of Premises r.
- �
(ple IL
4'e print)
Ts
Signature ,/ Title MAI Pt
(over)
DOH-1555 (02/2004)