Felthousen, Robert 1
NEW YORK STATE DEPARTMENT OF HEALTH ' ft
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert R. Felthousen Male
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 11 / 2016 85 War or Dates
i. Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death E Natural Cause Accident Homicide E Suicide ❑Undetermined 0 Pending
ttiCircumstances Investigation
ILI Medical Certifier Name Title
ilk Zeshan Latif MD
Address
211 Church St Saratoga Springs, NY 12866
!> Death Certificate Filed District Number Register Number
10 City, Town or Village Saratoga Springs h, s'()i r-1 9
=Burial Date Cemetery or Crematory
03 / 14 / 2016 Pine View Crematory
Mili Li Entombment Address
ECremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
s Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
liN Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
2
l
Permission is hertby granted to dispose of the human rema" c ' ed a�e indicate .
z> Date Issued Registrar of Vital Statistics
(signature)
:!gi District Number ..� 5t-,( Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
W Date of Disposition 3) is J it Place of Disposition R.11,.✓ (*re q f orui,...
(address)
tii
= (section) ili(lot number) (grave number)
= Name of Sexton or Person in Charge of Premises �t„ t S4-.nl�"
► ' (pl ase print) •
Signature Title f M/IVii—
(over)
DOH-1555 (02/2004)