Kehl Sr, Walter .` it3°8
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Walter K. Kehl Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
04/23/2015 86 years War or Dates
- Place of Death Hospital, Institution or
City, Tov CRIXVitakX Saratoga Springs Street Address 278 Saratoga Blvd
• Manner of Death❑, latural Cause ❑Accident El Homicide El Suicide III Undetermined ❑Pending
i Circumstances Investigation
W Medical Certifier Name Title
David Kandath M D
Address
6 Care Lane Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, ToyXr /AX Saratoga Springs 4501 215
• ❑Burial Date Cemetery or Crematory
❑Entombment 04/24/2015 Pine View Crematory
Address
: ❑cremation Queensbury, N Y
Date Place Removed
..Z ❑Removal and/or Held
and/or Address
r= Hold
IA
0 Date Point of
N ❑Transportation Shipment
a by Common Destination
Ei Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Springs, NY
Name of Funeral Firm Making Disposition or to Whom
fko, Remains are Shipped, If Other than Above
Address
IX
IW
! ` Permission is hereby granted to dispose of the human remain ibe abojs ' dicated.
`
Date Issued 04/24/2015 Registrar of Vital Statistics ` —
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fi-
Place of Disposition ga.... C� x.,
�! Date of Disposition ��L��IS' P �'
2 (address)
LIJ
VI
11 (section) -(lot numbr) (grave number)
Name of Sexton or Person in C arge of Premises 6�,s
z tfIlLase print)
ill
Title � n��4
Signature '�
(over)
DOH-1555 (02/2004)