Morris, Wesley NEW YORK STATE DEPARTMENT OF HEALT'k . 67
Vital Records Section Burial - Transit Permit
i Name First Middle Last Sex
Wesley Morris Male
i Date of Death Age If Veteran of U.S. Armed Forces,
01 / 16 / 2016 58 War or Dates
}- Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death❑Natural Cause El Accident El Homicide E Suicide 0 Undetermined �Pending
Iti Circumstances Investigation
la Medical Certifier Name Title
44 Robert S. Wang MD
Address
6 Care Ln, Saratoga Springs, NY 12866
Mil Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs
0Burial Date Cemetery or Crematory
01 / 22 / 2016 Pine View Crematory
;<a Entombment Address
• Cremation Queensbury, NY
Date Place Removed
g;❑Removal and/or Held
and/or Address
Hold
Date Point of
Pti Q Transportation Shipment
L by Common Destination
Carrier
Q Disinterment Date Cemetery Address
in
Q Reinterment Date Cemetery Address
Aii
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
`3 Address
?i 402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is ereb granted to dispose of the human rem ' Cr' ed albpy indicat
3
Date Issued i egistrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IM Date of Disposition //zS ffks Place of Disposition
,E.4 kJCaw .
(address)
iii
IZ (section) (lot number) (grave number)
0 Name of Sexton or Person iP Charge of emises try►✓�/�� (pl ase print'• //11
W. Signature J. � Title It/(.
(over)
DOH-1555 (02/2004)