Katz, Morris IF ft 51)
NEW YORK STATE DEPARTMENT OF HEAJTH
Vital Records Section Burial - Transit Permit
'» Name First Middle Last Sex
Morris Katz Male
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 22 / 2015 94 War or Dates 1940 - 1945
Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
a Manner of Death®Natural Cause 0 Accident ❑Homicide 0 Suicide 0 Undetermined 7 Pending
Circumstances Investigation
jut Medical Certifier Name Title
P. Elizabeth Valentine MD
Address
fiF 211 Church St, Saratoga Springs, NY 12866
(« Death Certificate Filed District Number Regi er
City, Town or Village Saratoga Springs
iiN OBurial Date . / / I� Cemetery or Crematory
Pine View Crematory
ffl;i Entombment Address
im®X Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
t= Hold
O Date Point of
Q Transportation Shipment
i by Common Destination
Carrier
iiii
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to 1 Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
lill Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
ffi
Permission is hereby granted to dispose of the human remai cri d ab'oo a •ndicate
iiNi,.' Date Issued 1-I22 6 Registrar of Vital Statistics f
(signature)
District Number 460 I Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7/VI I(C Place of Disposition ?.4U,,, �r,, ,r.
E. (address)
tit
CC (section) j (lot number e. (grave number)
Name of Sexton or Person i0 Charge of Premises r� P✓+�et1
z ( ease print) •
Signature Z� Title Mk►► 3r�.
(over)
DOH-1555 (02/2004)