Putnam, Neils •
NEW YORK STATE DEPARTMENT OF HEALTW-+ 1 I SZ
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Neils C. Putnam Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/01/2015 35 years War or Dates
i-.. Place of Death Hospital, Institution or
X City, T Street Address
Ltt °X l°lf X Saratoga S rings Saratoga Hospital
p Manner of Death Q,Natural Cause Li Accident ❑Homicide 0 Suicide ri Undetermined El Pending
VCircumstances Investigation
fij Medical Certifier Name Title
Daniel J. Kuhn Cnronpr
Address
40 McMaster Street, Ballston Spa, N Y 12020
Death Certificate Filed District Number Register Number
City, ToPx �NX Saratoga Springs 4501 113
DBurial Date Cemetery or Crematory
❑Entamt ment 0"04""2015 Pineview Crematory
Address
' [cremation 0ueensbury, N Y
Date Place Removed
9❑Removal and/or Held
and/or
;;; Address E
10
Hold
{ Date Point of
ti ❑Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
'_< ❑Reinterment Date Cemetery Address
<; Permit Issued to Registration Number
gI Name of Funeral Home Densmore Funeral Home 00448
fti Address
7 Sherman Ave, Corinth, New York 12822
iii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
to
` Permission is hereby granted to dispose of the human remain ib abQas' dicated.
Date Issued 03/03/2015 Registrar of Vital Statistics
(signature)
District Number Place
iiiiil 4501 Saratoga Springs
:':', I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I
2
tit Date of Disposition 3J S)/S- Place of Disposition f 'iL..1 ` on_.-
2 ( s)
Ili
ilk
1C (section) //_ (lot number (grave number)
taName of Sexton or Person in Charge of Premises ��'l 3oA^
2 X, please print)
tij,i Signature � �— Title i(M'wO3r
(over)
DOH-1555 (02/2004)