Michaud, Gary NEW YORK STATE DEPARTMENT OF HEALTH t 9 I
Vital Records Section ,. Burial - Transit Permit
Name Firt Middle Last Sex
ary Michaud Male
Date of Death Age If Veteran of U.S. Armed Forces,
iiiigi 02/10/2015 63 years War or Dates Viet Nam
▪ Place of Death Hospital, Institution or
Znall,K Town oaararglt Town of Saratoga Street Address 81 Caldwell Road
3 Manner of Death 0 Natural Cause 0 Accident 0 Homicide Suicide �Undetermined 0 Pending
U1 Circumstances Investigation
tu Medical Certifier Name Title
Jenny Romero MD
Address
6 Medical Park Drive, Malta, Ny 12020
Death Certificate Filed District Number Register Number
Riii!XgX9cTown 0001,3k16 Town of Saratoga 4565 1
ni❑Burial Date Cemetery or Crematory
02/11/2015 Pine View Crematorium
i; ❑Entombment Address
,_ Cremation 21 Quaker Rd., Queensbury, NY
Date Place Removed
❑Removal and/or Held
2 and/or Address
i=" Hold
CA
0 Date Point of
Transportation Shipment
c fby Common Destination
iiii Carrier
a El Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
iiM Permit Issued to Registration Number
giiiii Name of Funeral Home Compassionate Funeral Care 00364
Oiii Address
402 Maple Ave., Saratoga Springs, NY
Pi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
t
to
Pi Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/11/2015 Registrar of Vital Statistics d,
(signature)
District Number -1 Place Town of Saratoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
,n
t pate of Disposition 2(itl,c Place of Disposition .VI—) (ram jdr
(address)
ES (section) 4 (lot number) (grave number)
c Name of Sexton or Person in C rge of Premises filrl) pSEA
lease print)
SignZ.
ailature h� Title C
(over)
DOH-1555 (02/2004)