Oana, Hillar NEW YORK STATE DEPARTMENT OF HEALTH* it4 3t
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Hiller Oana Male
Date of Death Age If Veteran of U.S. Armed Forces,
01/12/2015 81 years War or Dates
1- Place of Death Hospital, Institution or
Z GXown orRtutx Wilton Street Address
23 New Britain Dave
W Manner of Death❑,Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending
to Circumstances Investigation
W Medical Certifier Name Title
Susan M Muller
M D
Address
114 Lawrence St Saratoga Springs
Death Certificate Filed District Number Register Number
ii GQtiown or WORIX Wilton 4569 3
❑Burial Date Cemetery or Crematory
ni
['Entombment Address
Pine View Crematory
Address
[ remation Queensbury. New York
Date Place Removed
,Z El❑Removal and/or Held
and/or Address
P.: Hold
th
0 Date Point of
fki❑Transportation Shipment
0 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
lilipl Name of Funeral Home Compassionate Funeral Care, Inc 00364
ni Address
402 Maple Ave. Saratoga Springs N Y 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
I
1" Permission is hereby granted to dispose of the human remai s described above as indicated.
Date Issued 01/14/2015 Registrar of Vital Statistics C�t,lt,t ,
(signature)
igi District Number gii 4569 Place Wilton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
iti Date of Disposition I /I6/15- Place of Disposition -gait.. C4irk,
(address)
Ili
CO
#C (section) lot number) (grave number)
0 Ci Name of Sexton or Person in Charge of Premises /�+r, Sew
2 �f/ Ltg
(plea a print)
Uf Signature Title t_
1 (over)
DOH-1555 (02/2004)