Holcomb, John z,2z
NEW YORK STATE DEPARTMENT OF HEALTH '`
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John L. Holcomb Male
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 18 / 2017 72 War or Dates 1968 - 1974
j-- Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
la
g Manner of Death®Natural Cause 0 Accident El Homicide El Suicide Undetermined 7 Pending
Circumstances Investigation
ta Medical Certifier Name Title
f Hung Nguyen MD
Address
19 West Avenue Saratoga Springs, NY 12866
iRii Death Certificate Filed District Number j 5 Register Number 12 j ^
iigiil City,Town or Village Saratoga Springs .' f�I 1J`V
>is»OBurial Date Cemetery or Crematory
03 / 20 / 2017 Pine View Crematory
Mi OEntombment Address
>':Ecremation Queensubury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
giiiiiii Q Disinterment Date Cemetery Address
iReinterment Date Cemetery Address
m LiPermit Issued to Registration Number
iiiii Name of Funeral Home Compassionate Funeral Care 00364
iim
ia Address
402 Maple Ave., Saratoga Sp., NY 12866
iiiii
iiiiiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Z
Ili
"` Permission is reby granted to dispose of the human remai ri abov ' dicate
Wiii
Date Issued 3 9 i
J 7 Registrar of Vital Statistics
If (signature)
' District Number LI5 ,) Place Saratoga Springs , New York
' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:N
Date of Disposition / 2l//7 Place of Disposition ?i2i u1 J e,�Q h..-y
a / // (address)
la
Er (section) 1 (lot number) (grave number)
II Name of Sexton or s n • Charge of Premises l' /,r -K 6a N'1 �G e
2 (please print) •
tii
o Signature / Title �'e-ml
(over)
DOH-1555 (02/2004)