Healy, Matthew 13'7
NEW YORK STATE DEPARTMENT O'F HEALTH
Vital Records Section Burial - Transit Permit
I:I:iiIiI Name First Middle Last Sex
Matthew R. Healy Male
RII Date of Death Age If Veteran of U.S. Armed Forces,
02 / 13 / 2017 31 War or Dates N/A
14 Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address 101 State Street
0 Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined 0 Pending
LilCircumstances Investigation
43
tu Medical Certifier Name Title
Q Susan Hayes Coroner
Address
40 McMaster Street, Ballston Spa., NY 12020
Death Certificate Filed District Number Register Nu
City, Town or Village Saratoga Springs HSIp'
Date CemeteryCrematory
> BUnal or 02 / 16 / 2017 Pine View Crematory
? ! Entombment Address
i•iIIIIIII LCremation Queensbury, NY
Date Place Removed
Z 0 Removal and/or Held
and/or Address
Hold
O Date Point of
DiQ Transportation Shipment
by Common Destination
Carrier
, Q Disinterment Date Cemetery Address
iIiIIiIIIIi
❑AIII: Reinterment Date Cemetery Address
Permit Issued to I Registration Number
iIIIIIIIIII Name of Funeral Home Compassionate Funeral Care 00364
Address
> 4 402 Maple Ave., Saratoga Sp., NY 12866
IlikIIIIi.i Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
ir
Ili
Permission is he by ranted to dispose of the human reins' s `-'bed ?e s indica d.
iaii
Date Issued 7. (� Z41 Registrar of Vital Statistics
(signature)
Oi District Number ysbl Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
itiI
W Date of Disposition 2l/7//7 Place of Disposition ?� 1k.).6.,,�,/ �.7 ij rTity
E. // / (address)
In
fa
CC (section) (lot number) (grave number)
0 Name of Sexton or P Charge of Premises J;,t.1'cL v7 (?rc-1414 4-4 e
Z - (please print) •
Signature Title C!air7 i11z'1/1 Vie,-4/e
s
(over)
DOH-1555 (02/2004)