Mingo Jr., Kenneth NEW YORK STATE DEPARTMENT OF HEALTH k t f
Vital Records Section 4 Burial - Transit Permit
Name First Middle Last Sex
Kenneth Louis Mingo Jr Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/14/2018 67 Years War or Dates
F* Place of Death Hospital, Institution or
L City, Town or Village Saratoga Springs Street Address Saratoga Hospital
iQ Manner of Death j Natural Cause 0 Accident ElHomicide 0 Suicide ❑Undetermined ❑Pending
U Circumstances Investigation
>t Medical Certifier Name Title
Christopher Case DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 544
OBurial Date Cemetery or Crematory
10/17/2018 Pine View Crematorium
❑Entombment Address
®Cremation Queensbury Town. New York
Date Place Removed
ZRemoval and/or Held
F.. and/or Address
= Hold
Date Point of
(71El Transportation ,' Shipment
G by Common Destination
Carrier d Atieri.-,—
Disinterment Date Cemetery Address
4.1
Reinterment Date Cemetery Address
„ Permit Issued to Registration Number
`E Name of Funeral Home Carleton Funeral Home Inc 00281
em Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
Ct Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/17/2018 Registrar of Vital Statistics jofrn PPrancktEfectronicaltySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1 Date of Disposition )v fit I i$ Place of Disposition L
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I J iin
(address)
UJ
it)
a: (section) (lot umber) (grave number)
pName of Sexton or Person in Charge of Premises t%^tl' ®�tMhi-
Z► (please nt)
W Ni
Signature r,(�' Title
(over)
DOH-1555 (02/2004)