Rawson Sr, Raymond r
22
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section •
Burial - Transit Permit
•
Name First Middle Last Sex
Raymond Calvin Rawson Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 02 / 2016 90 War or Dates 1945-1946
14 Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital
pManner of Death EZ Natural Cause El Accident El Homicide _Suicide Undetermined �Pending
Iii Circumstances Investigation
ul Medical Certifier Name Title
Q Romel H. Gobunsuy MD
Address
im
Ul 211 Church Street, Saratoga Springs, NY
Death Certificate Filed
ed District Number �15� 1 Register Number
City, Town or Village Saratoga Springs 11(0
<! DBurial Date Cemetery or Crematory
10 / 04 / 2016 Pine View Crematory
QEntombment Address
Cremation Queensbury, NY
Date Place Removed
g.❑Removal and/or Held
a and/or Address
E="` Hold
CO
{v Date Point of
th 0 Transportation Shipment
c. by Common Destination
Carrier
Q Disinterment Date Cemetery Address
iiiiiii Dat --.. Cemetery Address
0 Reinterment
i Permit Issued to f Registration Number
Name of Funeral Home Compassionate Funeral Care I 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
X Address
III
Permission is hereby granted to dispose of the human remain ib abgTa " icated.
IA
Date Issued in 12, 90i Registrar of Vital Statistics �)w� 1 •
r (signature)
lii
District Number0` Place Saratoga Springs , New York
H t�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition ID/5'i L CI Place of Disposition .) eilomotofµ..
(address)
IILE
0
fr (section) fj (lot numbe�r'" (grave number)
gName of Sexton or Person in Charge of Premises /ns r !unlit
,���� lease print) .
3 [ G.t 4'I Title 0�AIM
Signature .
(over)
DOH-1555 (02/2004)