Weber, Gene Ir a
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Mii Name First Middle Last Sex
Gene Edward Weber Male
;;; Date of Death Age If Veteran of U.S. Armed Forces,
08 / 30 / 2016 81- War or Dates N/A
} = Place of Death Hospital, Institution or
jCity, Town or Village Northumberland Street Address 17 Homestead Road
0 Manner of Death Natural Cause 0 Accident 0 Homicide E Suicide �Undetermined �Pending
US 'I Investigation
tu Medical Certifier Name Title
itt Robert Nielson MD
Address
3044 NY-50, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City,Town or Village Northumberland
<> oBurial Date Cemetery or Crematory
08 / 31 / 2016W pm Pine View Crematory
> ;, fl Entombment Address
Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
4❑Removal and/or Held
and/or Address
Hold
Date • Point of
Q Transportation Shipment
by Common Destination
Carrier
Q DisintermentDate Cemetery Address
Q Reinterment Date Cemetery Address
ViiiiPermit 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
Ilt
In
Permission is hereby ranted to dispose of the human remains describe above as indicated.
Oi
>` I Date Issued g " Registrar of Vital Statistics ;SQ "L, ,(¢ Z{ i
(signature)
District Number 21:57L/ Place Northumberland , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ili Date of Disposition /I((o, Place of Disposition .acV f' tort,,--.
(address)
ILI
I (section) (lot numbat) (grave number)
Ci
iQ Name of Sexton or Person in Charge of Premises AlpL
Jam
/ (please print)
W. Signature (�� Title Cg► a.
•
(over)
DOH-1555 (02/2004)