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Meyer, Christopher l• s �] (14 NEW YORK STATE DEPARTMENT OF HEALTH �� " Vital Records Section Burial - Transit Permit Name First Middle Last Sex Christopher R. Meyer Male Date of Death Age If Veteran of U.S. Armed Forces, 07 / 09 / 2016 28 War or Dates .14 Place of Death Hospital, Institution or City, Town or Village Northumberland Street Address 460 W River Rd 0 Manner of Death L. Natural Cause 0 Accident E Homicide g Suicide Undetermined �Pending Circumstances Investigation iti Medical Certifier Name Title 0 P1141-- ruqo Address 'l Z M K VOW .1A-CLJ1VI3 sr`' NU/(1467(0 Death Certificate Filed District Number Register Number City,Town or Village Northumberland <> Burial Date Cemetery or Crematory 07 / 13 / 2016 Pine View Crematory Entombment Address Cremation Queensbury, NY ii:i:i Date Place Removed ❑Removal and/or Held Ew and/Holdor Address tg Date Point of Q Transportation Shipment is by Common Destination Carrier Niii Q Disinterment Date Cemetery Address Q Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care, Inc 00364 iiiiiiiI Address 402 Maple Ave., Saratoga Springs, NY 12866 si Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address it Ifir .. Permission is hereby granted to dispose of the human emainsQ described above as indica d. IDate Issued © ti a 1 j p Registrar of Vital Statistics ,q� (sig ature -)A'f)- District Number H3 i3 Place Northumberland , New York `'' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: #- Z 41 Date of Disposition 1113)/b Place of Disposition eint 116--,, (t7v 4010,,. (address) La 0. (section) _ (lot number) (grave number) :g Name of Sexton or Person in Charge of Premises gott-cr �Ph/} ase print) • Signature �` L Title CMfet - • (over) DOH-1555 (02/2004)