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Corbo, John Jun. 6. 2018 3:1U11 t No. 33bU N. 1 sli yO NEW YORK STATE DEPARTMENT OF HEATH A. Vital Records Section Burial - Transit Permit Name First Middle Last Sex So° John Paul Corbo Male Death Age If Veteran of U,S, Armed Forces, RV 06/ 07/ 2018 82 War or Dates 1953-1961 Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Mary's Haven Manner of Death 21 Natural Cause Li Accident 0 Homicide El Suicide Q Undetermined ©Pending Circumstances Investigation Medical Certifier Name Title Tenej a Sanjay MD Address _ 294 Grand Ave, Saratoga Springa, NY 12866 gig Death Certificate Filed District Number Regist r ber. City,Town or Village Saratoga Springs L col 3 ©Burial Date Cemetery or Crematory 1 y 06 / 11 / 2018 Pine View Crematory w©Entombment Address - ®Cremation __ Queensbury, NY Date Place Removed : ri Removal and/or Held and/or Address Hold Date Point of „ Transportation Shipment _ by Common Destination Carrier Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address w Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care 00364 - Address 402 Maple Ave., Saratoga Sp., NY 12866 A Name of Funeral Ftrm Making Disposition or to Whom Remains are Shipped, If Other than Above -. Address Q Permisalon la h rob granted to dispose of the human rem ' or ad ebr indioat Date Issued C Registrar of Vital Statistics I M!Y (slgOatun) ,; District Number 4 5D Place Saratoga Springs , New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition (o/i t I ig Place of Disposition _ t? ...- 4,�,,i-o,,,_, . (address) (secdan) (yet member) (gray.number) Name of Sexton or Person ip Charg of Premises •- G /;.j. -�a (dal..print)I Signature Title t (over) DOH-1 555 (02/2004)