Sheehan, Sean f `
4.
NEW YORK STATE DEPARTMENT OF HEALTH D
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ni Sean S. Sheehan Male
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 18 / 2016 45 War or Dates N/A
j- Place of Death Hospital, Institution or
Ti City, Town or Village Saratoga Springs Street Address 20 Northway Court
w Manner of Death®Natural Cause Accident ❑Homicide ❑Suicide 0 Undetermined �Pending
Circumstances Investigation
tu Medical Certifier Name Title
c Daniel J. Kuhn Coroner
Address
Ni 40 McMaster St., Ballston Spa., NY 12020
Mii Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs
gi$12Burial Date Cemetery or Crematory
01 / 20 / 2016 Pine View Crematory
0 Entombment Address
gi l Cremation Queensbury, Ny
iM Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
'Q Transportation Shipment
a by Common Destination
< ;]; Carrier
`` El Disinterment Date Cemetery Address
11 Date Cemetery Address
Q Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
f
" Permission is hereby granted to dispose of the human rem ' cr' ede indicated.
igil
iiiiiN: Date Issued I Registrar of Vital Statistics
iiliiiig (signature)
ig District Number 1450 i Place Saratoga Springs , New York
. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ►/4 hio Place of Disposition .PneV41,.. 1tr,1101(0t;✓N-..
2 (address)
la
0
ES (section) 4 (lot number) _ (grave number)
ad
of Sexton or Person ip Charge of Premises . l/]rut + -.Si r1t'H-
zr. ' (please pent) •
Signature ��tit ' Title ft W(l
(over)
DOH-1555 (02/2004)