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Smeltzer Jr., James I r # 7°3 NEW YORK STATE DEPARTMENT OF HEALTH # Burial - Transit Permit Vital Records Section Name First Middle Last Sex ii James E.Smeltzer Jr. ., Male IN Date of Death Age If Veteran of U.S. Armed Forces, 09/17/2017 33 Years War or Dates Hospital, Institution or Place of Death P City, Town or Village Saratoga Springs i Street Address Saratoga Hospital Manner of Death©Natural Cause Accident Homicide �Suicide Undetermined Pending Circumstances Investigation al Medical Certifier Name Title Timothy Waters DO ▪f Address 211 Church St,Saratoga Springs,New York 12866 '▪, Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 457 ❑Burial Date Cemetery or Crematory 09/19/2017 Pine View Crematory ▪ ❑Entombment Address ,®Cremation Queensbury Town, New York 'F Date Place Removed il❑Removal and/or Held and/or Address Hold k." Date Point of Transportation Shipment �-i by Common Destination , Carrier EA. Q Disinterment Date Cemetery Address r Q Reinterment Date Cemetery Address Permit Issued to Registration Number F.; 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 Remains are Shipped, If Other than Above =i Address pi Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/19/2017 Registrar of Vital Statistics John Tranck E ctronicalfysignd (signature) District Number 4501 Place Saratoga Springs, New York $ ,, I certify that the remains of the decedent identified above were disposed ofin accordance with this permit on: ri Date of Disposition 1121 f fl Place of Disposition Fatin�. i tom►.. (address) (section) j (lot number) (grave number) : Name of Sexton or Person in Charge o Premises Arrs'i f Jd�rtg' (p! se print) Signature a *E1- Title f E*I (t (over) DOH-1555(02/2004)