Mabb, Daniel . 41(.7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
>< Name First Middle Last Sex
Daniel D. Mabb Male
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 16 / 2018 56 War or Dates N/A
f.. Place of Death Hospital, Institution or
ZCity, Town or Village Milton 1 Street Address 33 Edmund Drive
0 Manner of Death Natural Cause ❑Accident 0 Homicide E Suicide 0 Undetermined 0 Pending
US Circumstances Investigation
til Medical Certifier Name Title
0 Roland T. Phillips MD
Address
6 Care Ln, Saratoga Springs, NY 12866
'' Death Certificate Filed District N mber Register Number
City,Town or Vi44age Milton ,j�/ //
ElBurial Date Cemetery or Crematory
02 / 19 / 2018 Pine View Crematory
y'`j fEntombment Address
Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address .
Hold
V.{ Date Point of
Q Transportation Shipment
by Common Destination
MI Carrier
Q Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
iii,ia Permit Issued to Registration Number
iN Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
>< Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
iu
Permission is here y granted to dispose of the human remains described abo a as in 'sated.
ia Date Issued / Registrar of Vital Statistics 4e ' �/.t___i..7/./YC__.-✓
(sign re)
Wi
District Number q5 6/ Place Milton , New
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 2i tg I'S Place of Disposition g�11J 4L9+--
z (address)
]n
U,
CA (section) 1(lot numbe (grave number)
Q
ci Name of Sexton or Person ip Charge of Premiss �,it
di ' ( ass print) •
ILI
Signature 1C" Title li't!'1}TUL
(over)
DOH-1555 (02/2004)