O'Leary, Robert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert O'Leary Male
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 15 / 2015 70 War or Dates N/A
1- Place of Death Hospital, Institution or
tkiCity, Town or Village Saratoga Springs Street Address
>t Manner of Death®Natural Cause 0 Accident �UndeterminedSaratogaHospital Pending
ending
Circumstances Investigation
til Medical Certifier Name Title
0 Jason Bernad MD
Address
211 Church St, Saratoga Springs, NY 12866
>':> Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs ej q --0; ' OBurial Date / / Cemetery r re atoryEntombment bO
Pine View Crematory
Address
>>QCremation 21 Quaker Road, Queensbury, NY
Date Place Removed
Z g ri❑Removal and/or Held
and/or Address
0
Hold
Date Point of
ofEiTransportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
! Permit Issued to Registration Number
Wil Name of Funeral Home Compassionate Funeral Care, Inc 00364
:> s Address
5 402 Maple Ave. , Saratoga Springs, NY 12866
Ibil Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
S
Permission is here y ranted to dispose of the human rema' cri d aim& indicate
Date Issued q kJ t Registrar of Vital Statistics
(signature)
in District Number Li 5.01 Place Saratoga Springs , New York
I certify that the remains of the decedent identified •above were disposed of iinn accordance with this permit on:
Date of Disposition l in11(S Place of Disposition zia...' (,qor,,
(address)
la
Ca
(section) A (lot number) (grave number)
0 Name of Sexton or Person in Charge Premises - ar, SR.•
dr- , ( lease print)
Signature Title ( N+ogkt
(over)
DOH-1555 (02/2004)