Whittaker Jr, George NEW YORK STATE DEPARTMENT OF HEALTI '-,
Vital Records Section Burial - ransit Permit
Name Fi s _ _,_. Middle Last Sex
Jr. — Geofge James(, Whittaker Male
Date of Death Age If Veteran of U.S. Armed Forces,
04/02/2016 68 years War or Dates
j-. Place of Death Hospital, Institution or
City, Tomes' qtt x Saratoga S •rings Street Address Sarato a H s ita!
Manner of Death Natural Cause u Accident ❑Homicide ❑Suicide undetermined ❑Pending
tit Circumstances Investigation
tu Medical Certifier Name Title
Robert Donnaruroma M D
Address
211 Church Street
Death Certificate Filed District Number Register Number
City, Tg ' X Saratoga Springs 4501 1Q2
❑Burial Date Cemetery or Crematory
❑Entombment 04/06/2016 Pine View Crematorium
Address
[Cremation Queensbury, N Y •
Date Place Removed
''❑Removal and/or Held
{ and/or Address
I= Hold
tip —0 Date Point of
Q El Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-mcdermott Funeral Home 00141
Address
9 Pine Street, Chestertown, N Y PIS,7
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
E Address
to
. Permission is hereby granted to dispose of the human remaicis"des ib abolo ' dicated
Date Issued 04/06/2016 Registrar of Vital Statistics [
(signature)
! District Number 4501 Place Saratoga Springs
".. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tJ Date of Disposition 1/-7- 16 Place of Disposition ?' ')et.Yrao G/Cii 1(4;T0 rt
2 (address)
Lu
U)
CC (section) J_t number) (grave number)
CI Name of Sexton o n Charge of Premises �1.�.,/1 a vl - ei-c•' e•-•
2 (please print)
la
Signature Title r&,fOr
(over)
DOH-1555 (02/2004)