Atkinson, Clifton NEW YORK STATE DEPARTMENT OF HEALTH # '1 I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
PiA
Clifton Harold Atkinson Male
Pt Date of Death Age If Veteran of U.S. Armed Forces,
02/28/2018 89 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑ Undetermined ri❑Pending
! liiti
Circumstances Investigation
Ril Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs, New York 12866
:f.,1 Death Certificate Filed District Number Register Number
ti City, Town or Village Saratoga Springs 4501 131
❑Burial Date Cemetery or Crematory
03/01/2018 Pine View Crematory
kzAi❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
el Removal and/or Held
and/or
igiAddress
Hold
NI
ril Date Point of
1 L j Transportation Shipment
IL
by Common Destination
41 Carrier
4 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
El Remains are Shipped, If Other than Above
Address
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/01/2018 Registrar of Vital Statistics John P Eranck(Efectronica1Cy Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ci
111 Date of Disposition 3't l y Place of Disposition '�,��,, /',..„..t,_
(address)
la
® (section) (lot number) (grave number)
Name of Sexton or Person in Charge of remises ([1 r= --Pt
ii
/�� ( le .Sase print)
Signature /.✓t Title (
(over)
DOH-1555 (02/2004)