Moore, Paul NEW YORK STATE DEPARTMENT OF HEALTF
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
` Paul S.Moore Male
',, Date of Death Age If Veteran of U.S. Armed Forces,
'Ai 11/10/2017 68 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death rej Natural Cause ❑Accident ❑Homicide E Suicide ❑ Undetermined ri❑Pending
Circumstances Investigation
Medical Certifier Name Title
Numan Rashid MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 559
;n ❑Burial Date Cemetery or Crematory
11/13/2017 Pine View Crematory
❑Entombment
g Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
3_ Date Point of
❑Transportation Shipment _
by Common Destination
• Carrier
• Disinterment Date Cemetery Address
.54 00 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
Iw,: 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 John cP<Franck, ECectrmricaaySigned
(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:
144
I Date of Disposition IN&it) Place of Disposition ,4 li 4,..1, oe,,,,
(address)
(section) ,(lot number) ( (grave number)
I Name of Sexton or Person in Charge of Prem' es G 4ri, J evoll
(pltase print)
Signature Title C( yA r14i P
(over)
DOH-1555 (02/2004)