Drake, Milton . Nt
A 6
NEW YORK STATE DEPARTMENT OF IAEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Milton E.Drake Male
D• ate of Death Age If Veteran of U.S. Armed Forces,
0• 7/09/2018 77 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
• Manner of Death RI Natural Cause 0 Accident 0 Homicide 0 Suicide �Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Rodney Ying MD
Address
ritt 211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 384
❑Burial Date Cemetery or Crematory
07/11/2018 Pine View Crematory
• ❑Entombment Address
ilf®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
- and/or
Address
• Hold
Date Point of
p,• Q Transportation Shipment
by Common Destination
Carrier
O Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
- Permit Issued to Registration Number
• Name of Funeral Home Alexander Baker Funeral Home 00037
iii Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
-- Address
r1
P• ermission is hereby granted to dispose of the human remains described above as indicated.
io, Date Issued 07/10/2018 Registrar of Vital Statistics John P Eranck(Electronically Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Yi /9
Date of Disposition 1)11 I19 Place of Disposition Q�� lrL-foa...
(address)
.
(section) (lot nymberi ( (grave number)
`' se
Name of Sexton or Person in Charge of Premises r.
411
(please int)
vi Signatureti
4 Title /06
(over)
DOH-1555 (02/2004)