Valle, Abelino i _ b
NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last - Sex
Abelino Valle Male
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 14 / 2016 85 War or Dates N/A
1: Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death®Natural Cause Accident ❑Homicide Suicide Undetermined 0 Pending
Circumstances Investigation
ui Medical Certifier Name Title
0 Zeshan Latif MD
Address
211 Church St, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register er
City, Town or Village Saratoga Springs c. O N/
>>nBurial Date Cemetery or Crematory
10 / 19 / 2016 Pine View Crematory
iii 8 Entombment Address
aCremation Queensbury, NY
:: Date Place Removed
Z❑Removal and/or Held
14 and/or Address
t Hold
C
C! Date Point of
iri❑Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
jai Permit Issued to ' Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
1 Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Cr
111
Permission is h by anted to dispose of the human rema d cri d ab 'ndicate
Date Issued her i'1 j lj Registrar of Vital Statistics `-.-.._.
i. (signature)
?`: District Number W j by Place Saratoga Springs , New York
;*:i; i I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
l Date of Disposition ID/Zo/lb /,n Place of Disposition t .✓ Ci-d ..4ori—
2 (address)
Jai
ill
IC (section) /'' -(lot number) (grave number)
IIName of Sexton or Person in Charge of Premises i4,J S1�l"*
z (please print)
s /4- fl4k
41 Signature t� Title 04mict
(over)
DOH-1555 (02/2004)