Sabo Sr, Nicholas NEW YORK STATE DEPARTMENT OF HEALTH , w (*.Y
Vital Records Section Burial - Try it Permit
Name First Middle Last Sex
Nicholas John Sabo Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
__
June 19, 2015 75 War or Dates
Place of Death Hospital, Institution or
City, Town or Village fA r c��{ Street Address Pleasant Valley Road
Manner of Deathii.i Natura'Cause 0 Accident 0 Homicide Suicide 1-1 Undetermined ❑ Pending
; Circumstances Investigation
Medical Certifier Name Title
I
John Esper,
Address
325 Main Street Hudson Falls, NY 12839
Death Certificate Filed District Number Register Number
City, Town or Village S 7S(, 7 3
, _❑Burial Date Cemetery or Crematory
June 23, 2015 Pine View Crematory
,.,.:�0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
- Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
°_ by Common Destination
Carrier
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number •
Name of Funeral Home M. B. Kilmer Funeral Home-Ar• le 01077
Address
123 Main St., Ar• le NY 12809
° Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
,I. Date Issued (,)Q3) is- Registrar of Vital Statistics S 104,1 (,1/ i>,
(signature)
District Number 5-)S6 Place
4. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
eu`n.e u:Yw C-!`avhcr ."vni
Date of Disposition 06/23/2015 Place of Disposition aker Road Queensbury,NY 12804
(address)
(section (lot number) (grave number)
•Name of Sexton or Person in Char e of Premises 1 I m o y 3rt/ne I
e -� (please print)
Signature Title Cr-ev,,G..4ory elq"
(over)
DOH-1555 (02/2004)