Baithazar, George NEW YORK STATE DEPARTMENT OF HEALTHJ,- 1 11 7411
Vital Records Section +v,_ Burial - Transit Permit
Name Firgeorge Middle) Nazar SeWale
DS8 81h Ag If Veteran of U.S. Armed Forces,
8 years War or Dates
.14 Place of Death Hospital, Institutionr
City, Town or Village Town Of Milton Street Address 8 Stone Church Rd Lot 42
10
Q Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
LU Circumstances Investigation
la
tu Medical Certifier N me, Title
O. Daniel J. Kuhn Deputy Corner
ACWOMmaster Steet, Ballston Spa Ny 12020
Certifi d Milton
Distt ,Number Roister Number
iiii 4,tilTown oA�
!.'.:;lii El Burial Date 09/11/2018 Cell3MigwSLrmli um
ii ['Entombment Address
Cremation ueensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
ri4 Hold
Date Point of
Si Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
>iii❑Reinterment Date Cemetery Address
Permit Issued to Compassionate Funeral Care Reunion Number
Name of Funeral Home
Addren2 Maple Avenue, Saratoga Springs, Ny 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
ft
tL
Permission is hereby granted to dispose of the human remai s describe�,ebs,ye as indicat
09/11/2018 / 1
Date Issued Registrar of Vital Statistics
(signature)
District Number 4561 Place Milton
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
UI• Date of Disposition q lit(I Q Place of Disposition Rqt)... (1(0...4d r,-.
M (address)
UI
CA
re (section) ,/i (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises [^tli..„/ Stow'tr
rb 4 (please print)
• Signature Title lt4Plrtfa
(over)
DOH-1555 (02/2004)