Allen, Walter ` It L102_
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Buria - Transit Permit
sw Name First Middle Last Sex
-4 Walter L.Allen Male
'. Date of Death Age If Veteran of U.S. Armed Forces,
.' 06/08/2018 75 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death X❑Natural Cause n Accident O Homicide O Suicide 0 Undetermined O Pending
g. Circumstances Investigation
Medical Certifier Name Title
Sergio Lema-Gutierrez MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 325
a OBurial Date Cemetery or Crematory
❑ 06/11/2018 Pine View Crematory
` ,A Entombment Address
®Cremation Queensbury Town, New York
ttt
Date Place Removed
Z C Removal and/or Held
Q and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier -
—
cp . El Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
4
,, Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
AV
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
uu
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/11/2018 Registrar of Vital Statistics ,John c Eranck(Ef ctronicaffy 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:
Date of Disposition 'iii!it Place of Disposition f u.- �',rie to.�„
a (address)
(section) (lotnumber) (grave number)
Name of Sexton or Person in Charge of Premises (ML, �G...4fi
z
6. (please print)
Signature Title ( /4ii,'t
(over)
DOH-1555 (02/2004)