Farrell, John 51)
NEW YORK STATE DEPARTMENT OF HEALTH # /'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John Patrick Farrell Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/20/2016 68 years War or Dates
i-, Place of Death Hospital, Institution or
2 City, To Street Address
W YrR�'fC��ftX Saratoga ups Sarato a Hospital
a Manner of Death Natural Cause Accident 0 Homicide ❑Suicide Undetermined �Pending
Circumstances Investigation
W Medical Certifier Name Title
Q Carlos A Ares Md
Address
211 Church St., Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, T
•oXIAWRVACIAIX Saratoga Springs 4,01 110
❑Burial Date Cemetery"�r rematory
❑Entombment 02/24/2016 _ID:- ' -Crematory
Address
[Cremation Queensbury. N Y
Date Place . .smo: J
Z Removal and/or Held _
I2and/or Address
= Hold
0 Date Point of
ehQ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc. 00364
Address
402 Maple Ave., Saratoga Springs, N Y
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2 Address
W
12` Permission is hereby granted to dispose of the human remains d ibed.above s indicated.
Date Issued 02/23/2016 Registrar of Vital Statistics L--.. C444vN1
(signature)
District Number 4501 Place Saratoga Springs
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z , ` I
W Date of Disposition Z'�Sl/b Place of Disposition �.y b,,J aPlw..
W (address)
N
CC (section) loth umber) (grave number)
pName of Sexton or Person in Charge of remises r 3b�^M
Z (pleelse print) •
W 4.4„,:wt,
Signature r,"l f Title
(over)
DOH-1555 (02/2004)