Tucker, Jeff NEW YORK STATE DEPARTMENT OF HEALTH II sA, Y73
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeff Tucker Male
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 13 / 2015 52 War or Dates
.....,
1 . Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
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a Manner of Death E Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined Ti Pending
Circumstances 'Investigation
ui Medical Certifier Name Title
0 Carlos A Ares .
MD
Address
.„.
59 Myrtle St # 300, Saratoga Springs, NY 12866
Death Certificate Filed district Number . Register Number
City, Town or Village Saratoga Springs i^l -IC)I '-5 5 J
OBurial Date Cemetery or Crematory
07 / 17 / 2015 ,
Pine View Crematory
Entombment Address
EiCremation , 21 Quaker Road, Queensbury, NY 12804
Date
Date Place Removed
Z.El Removal and/or Held
.... "—I and/or Address
Hold
Date Point of -.
-
—L.j Transportation
in r—i Shipment
, E by Common Destination
Carrier .
Date . Cemetery Address
im 0 Disinterment
lai_ Date Cemetery Address
im L j Reinterment ,
Permit Issued to Registration Number
I Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
, _ t Remains are Shipped, If Other than Above
2 Address
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!1.!' Permission is h rel b; ranted to dispose of the human rerna" cri d abv,e indicate .
Date Issued Registrar of Vital Statistics 1 -
(signature)
District Number LI 6'0 I Place Saratoga Springs , New York
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......." :::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Z
W Date'-of Disposition -71 lib 5- Place of Disposition Zi,U........ 6,40(0.—
(address)
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til,
(section) n (lot number) (grave number)
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1:1 Name of Sexton or Person in Charge of Premises -. . air.44-- .3/0,AvisN
5 4-.. ir_. (p ase print) .
Signature Title raphiTctit,
(over)
DOH-1 .,,
..,....
DOH-1555 (02/2004)
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