Kennedy, Francis t ift # so,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:m Name First Middle Last Sex
Francis Paul. Kennedy Male
°x Date of Death Age If Veteran of U.S. Armed Forces,
=.:' July 15,2016 77 War or Dates Army 1961-1964
s° Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
q Richard Kim MD
Address
211 Church Street,Saratoga Springs,NY 12866
4a: Death Certificate Filed District Number Register Number
'R+y: City, Town or Village Saratoga Springs 4501 325
❑Burial Date Cemetery or Crematory
II Entombment July 18, 2016 Pine View Crematory
Address
❑x Cremation Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
9 and/or Address
Hold
C,)
°0 Date Point of
nTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
x. a Name of Funeral Home William J. Burke & Sons Funeral Home 01827
Address
°= 628 North Broadway, Saratoga Springs,NY 12866
? Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
NI Address
g
', Permission is hereby granted to dispose of the human remains ' e boxed; ' icated.
'', Date Issued July 18,2016 Registrar of Vital Statistics r.
(signature)
., District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7i MO, Place of Disposition ?ov, SA,J (jmetik .
X (address)
W
W (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises £ €M010g_
Z Etase Tint)
Signature l.� Title
(over)
DOH-1555 (02/2004)