Hoag, Clifford F r .
NEW YORK STATE DEPARTMENT OF HEALTH 3g
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Clifford Hoag Male
Date of Death Age If Veteran of U.S. Armed Forces,
01 I 12 / 2016 78 War or Dates Army 1955-1963
i Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
Q Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide �Undetermined �Pending
Circumstances Investigation
La Medical Certifier Name Title
Q Derek W. Smith MD
Address
100 Park St, Glens Falls, NY 12801
iiw Death Certificate Filed District Number Register Number
City,Town or Village saratoga springs
fBurial Date Cemetery or Crematory
Mil 01 / 13 / 2016 Pine View Crematory
' ®Entombment Address
E3Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
mi
M Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Tr
w
':` Permission is hereby granted to dispose of the human rem ' or' ed abp indicat .
Date Issued • ' Registrar of Vital Statistics r
gi
(signature)
'<€ District Number 45 1 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition J/i 5 II(. Place of Disposition enc tat(,.. CM'ACi.0no..,
2 (address)
w
0
at (section) (lot number) C (grave number)
O Name of Sexton or Person ip Charge of remises �P,s !; Se��C�+
► `7 (• =se print) .
• Signature v` •1 Title (1 11A 1Z
(over)
DOH-1555 (02/2004)