Hughes, Kirk 4 . _ .1
NEW YORK STATE DEPARTMENT OF HEALTH _..a,
Vital Records Section0. Burial - Transit Permit
Name First Middle Last Sex
Kirk Hughes
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 08 / 2017 69 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address 16 Kirby Road Apt A
1;140 Manner of Death®Natural Cause E Accident Homicide ❑Suicide ❑Undetermined ❑Pending
iliCircumstances Investigation
Medical Certifier Name Title
Address
la Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs .a �4-)...-
EiBurial Date Cemetery or Crematory
07 / 14 / 2017 Pine View Crematory
;;:;:i0Entombment Address
ECremation Queensbury, NY
Date Place Removed
,irk❑Removal and/or Held
and/or Address
01
Hold
Date Point of
Q Transportation Shipment
I by Common Destination
ig Carrier
Q Disinterment Date Cemetery Address
'ii Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
<'> Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
US
`: Permission is he eby granted to dispose of the humanai d cribeja e as ind' ted.
Date Issued J�Ii'") Registrar of Vital Statistics t
(signature)
District Number LI + .) Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
til Date of Disposition 7 JMOO Place of Disposition -�,i,J,),✓ C -(a'-
(address)
ill
CC (section) /y(lot number) (' (grave number)
flName of Sexton or Person in Charge f Premises G/r•t � 3swit
,�►� (ple se print) •
Signature O �� Title ll?,cnail,
(over)
DOH-1555 (02/2004)