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Necatera, Marc • NEW YORK STATE DEPARTMENT OF HEALTH 4 �� Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marc R.Necatera Male Date of Death Age If Veteran of U.S. Armed Forces, `gym- 11/11/2017 53 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause El Accident ❑Homicide ❑Suicide Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Rodney Ying MD Address 211 Church St,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number '4 City, Town or Village Saratoga Springs 4501 557 ❑Burial Date Cemetery or Crematory 11/15/2017 Pine View Crematory El Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/13/2017 Registrar of Vital Statistics lohnc'ranck Electronically Signed (signature) District Number 4501 Place Saratoga Springs, New York certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition fi/t6I Ii Place of Disposition (address) (section) /�f (lot number) (" (grave number) Name of Sexton or Person in Charge of Premises lh ri s (pie se print) Signature �� Titled (over) DOH-1555 (02/2004)