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VanDuren, Paul NEW YORK STATE DEPARTMENT OF HEALTH BUr�aI _ Transit Permit Vital Records Section Name First Middle Last Sex " Paul J.VanDuren Male Al-, Date of Death Age If Veteran of U.S. Armed Forces, 12/02/2017 71 Years War or Dates t: Place of Death Hospital, Institution or Z City, Town or Village Saratoga Springs Manner of Death Street Address Saratoga Hospital ©Natural Cause 0Accident Homicide 0Suicide Undetermined Pending 4-1 Circumstances Investi•ation Medical Certifier Name Title Derek Smith MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 615 ❑Burial Date Cemetery or Crematory 12/07/2017 Pine View Crematory ❑Entombment Address w ''®Cremation Queensbury Town, New York ;. Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Transportation Shipment ai by Common Destination Carrier Q Disinterment Date Cemetery Address w Q Renterment 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 F- Remains are Shipped, If Other than Above S Address te Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2017 Registrar of Vital Statistics jofin T Franck, El ctronicafysigned (signature) `t' District Number Place 4501 Saratoga Springs, New York f I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition f21 S l it Place of Disposition f(/_ 4 i - (address) t (section) n (lot number) (grave number) Name of Sexton or Person in Charge of Pr mises /4,` S i,,,i t� (p a print) v Signature 1J .r Title Ciif lit (over) DOH-1555 (02/2004)