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Mason, Robert NEW YORK STATE DEPARTMENT OF HEALTH 5 ✓ Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert Mason Date of Death Age If Veteran of U.S. Armed Forces, 08 / 09 / 2015 66 War or Dates }- Place of Death Hospital, Institution or City, Town or Village albany Street Address Albany Medical Center Ui a Manner of Death®Natural Cause E Accident 0 Homicide E Suicide �Undetermined ❑Pending I Circumstances Investigation tu Medical Certifier Namp Title o AQJV i�avht' /VD Address Li3 ,tom occAAa v-4 76kl 1x,vt y �V taa o' Death Certificate Filed District Number Register Number iqi City, Town or Village albany l 0 1 / 7©b <>0Burial Date /la / a�) Cemetery or Crematory Pine View Crematory Entombment I ,---)*.a U,e..-` Address Cremation Queensbury, NY ``" Date Place Removed 3❑Removal and/or Held Eul and/Holdor Address 40 0 Date Point of Q Transportation Shipment by Common Destination Carrier Q Disinterment Date Cemetery Address s Q Reinterment Date Cemetery Address gt Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care, Inc 00364 Address 402 Maple Ave. , Saratoga Springs, NY 12866 °<<l Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Ilr Permission is hereby granted to dispose of the human remains described aboovv as indicated. Date Issued 0��(I /c�0 I � Registrar of Vital Statistic �� ,�Q - %`r eC/ ✓� ,1Y ,,„„„:,. (signature 5 iial '< District Number tot Place albany , New York ((�� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 100 Z � I Date of Disposition $J(9I15' Place of Disposition �f,��,,, cµ„0-6,.r,,,� (address) lAi CC (section) (lot number) (grave number) 0 Name of Sexton or Person i.p Charge of Premises . (ir‘,1 -Lt Stolif ,Z & (please print) • i Signature A� Title titioitait _ (over) DOH-1555 (02/2004)