Hodgson, Hugh NEW YORK STATE DEPARTMENT OF HEALTH
# 76D
Vital Records Section Burial - Transit Permit
.! Name First Middle Last Sex
Hugh Hodgson Male
Date of Death Age I If Veteran of U.S. Armed Forces,
10 / 16 / 2016 89 War or Dates
14 Place of Death Hospital, Institution or
it City, Town or Village Greenwhich Street Address 30 Washington st. Apt E
Q Manner of Death E Natural Cause 0 Accident 0 Homicide ❑Suicide FlUndetermined ri"—I Pending
tt CircumstancesInvestigation
ta Medical Certifier Name Title
ci Edward M. Liebers MD
Address
3 Care Ln # 300, Saratoga Springs, NY 12866
<> Death Certificate Filed District Number Register Number
fiq City, Town or Village Greenwhich
> >EIBUrial Date Cemetery or Crematory
10 / 17 / 2016 Pine View Cremation
giy(Entombment Address
ECremation Queensbury,
pg: Date Place Removed
❑Removal and/or Held
and/or Address
Hold
fl Date Point of
triQ Transportation Shipment
a by Common Destination
Carrier
iiiiii
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
ggi
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
wiii
Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
it
In
'` Permission is hereby granted to dispose of the human remains described� above as indicated.
>� Date Issued /O/)` ifia Registrar of Vital Statistics i �-t'i--C aizto 1 .
(signatur
:'' District Number �i� Place Greenwhich , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
III Date of Disposition /01 I I lit. Place of Disposition fat VA,,, C .4orm ,
2 (address)
tip
01
LC (section) //' (lot number (grave number)
aName of Sexton or Person in Charge of Premises /.fir+ �f"AJl
(please print) .
tl� Signature 'c Title COL N Actt
(over)
DOH-1555 (02/2004)