Hallock, Michael NEW YORK STATE DEPARTMENT OF HEALTH gIS
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael E. Hallock Male
Date of Death Age I If Veteran of U.S. Armed Forces,
11 / 20 / 2016 68 War or Dates N/A
}- Place of Death Hospital, Institution or
jCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
Q Manner of Death® Natural Cause Accident E Homicide 0 Suicide Undetermined �Pending
in Circumstances Investigation
at Medical Certifier Name Title
44 Carlos A. Ares MD
Address
59 Myrtle St # 300, Saratoga Springs, NY 12866
M:;;i Death Certificate Filed District Number Register Number
>> City, Town or Village Saratoga Springs ,55J
Burial Date Cemetery or Crematory
11 / 22 / 2016 Pine View CreaQtory
Iliiii 0 Entombment Address
SCremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or
Address
t Hold
CA
Date Point of
a['Transportation Shipment
by Common Destination
Carrier
0 Q Disinterment Date Cemetery Address
im: Q Reinterment Date Cemetery Address
liiiii
Permit Issued to ; Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
,gl 402 Maple Ave., Saratoga Sp., NY 12866
itig Name of Funeral Firm Making Disposition or to Whom
ti.4 Remains are Shipped, If Other than Above
a Address
ill
flit
Permission is hereby granted to dispose of the human remade ri d atop, 'ndicate
iiii; Date Issued I' Iiiiii
22\i� r"Q Registrar of Vital Statistics
(signature)
District Number I ' 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 ///Z311L Place of Disposition , rat ,, (s maiort .
(address)
ILI
lc (section) // (lot number) c (grave number)
gName of Sexton or Person in Charge of Premises �lr.+ vi^'t I t
z (pease print) .
Signature Title C rn�p�
(over)
DOH-1555 (02/2004)