Darling, Eugene r I 34
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Trant it Permit
I Name First Middle Last Sex
Eugene Darling Male
Date of Death Age If Veteran of U.S. Armed Forces,
05 / 12 / 2016 76 War or Dates 1958-1961
14 Place of Death Hospital, Institution or
City, Town or Village Northumberland Street Address 13 Castlewood Dr.
141
0 Manner of Death®Natural Cause 0 Accident Homicide 0 Suicide ❑ Undetermined Pending
itiCircumstances Investigation
to Medical Certifier Name Title
0 Thomas J. Socash MD
Address
114 S Shore Rd, Old Forge,` NY 13420
Death Certificate Filed District N }?p J Register tuber
it City, Town or Village Northumberland � 7
°`` OBUCIaI Date Cemetery or Crematory
05 / 16 / 2016
Entombment Pine View Crematory
ffl Address
ECremation Queensbury, NY
Date Place Removed
2❑Removal and/or Held
and/or Address
Hold
gi
Date Point of
,. Q Transportation Shipment
by Common Destination
NJ Carrier
nii
Q Disinterment Date Cemetery Address
: Q Renterment Date Cemetery Address
` <P Permit Issued to Registration Number
iMi Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
iliiiii
€s Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t
. Permission is hereby granted to dispose of the human remains described above as indic ted.
Date Issued 5\ li 5 1,10i(t,Registrar of Vital Statistics1_)_ AS J;,.9..- L*
(sign ture)
Mi District Number 645 Place Northumberland , New York
Pili
;>:. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
to• Date of Disposition 4-'ith�, Place of Disposition prit U tr,,/ an
(address)ILI
-
w
Cr (section) it (lot number) (grave number)
0 Name of Sexton or Person in Char a of Premises
5
2 ( lease print) •
▪ Signature Titlea-
,,,,,,,
DOH-1555 (02/2004)