Furey, Jeremy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeremy J. Furey Male
Date of Death Age If Veteran of U.S. Armed Forces,
06 / 25 / 2018 27 War or Dates
14 Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital
QManner of Death®Natural Cause 0 Accident 0 Homicide E Suicide 71 Undetermined ri Pending
ltt Circumstances Investigation
al Medical Certifier Name Title
Michael Sikirica Coroner
gi Address
50 Broad St, Waterford, NY 12188
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs
igiiiDBurial Date Cemetery or Crematory
07 / 02 / 2018 Pine View Crematory
fl Entombment Address
Cremation Queensbury, NY
Date Place Removed
In Removal and/or Held
and/or
Address
Hold
w
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
iN Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
cc
l
Permission is hereby anted to dispose of the human rema' cri d abo a as indicated.
Date Issued % Registrar of Vital Statistics . -4-1,t4i,ik
(signature)
District Number Ll cU Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
liti Date of Disposition 11 d is Place of Disposition f,,v
(address)
tia
CC (section) /lot number) (grave number)
CIName of Sexton or Person in Charge of Premises /�'. �t,, 1'
z
(p/eise print)
iiiii
Signature d Title (i�l�►li
(over)
DOH-1555 (02/2004)