Jaquish, Linc NEW YORK STATE DEPARTMENT OF HEALTH s `y,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Linc Barton Jaquish Male
Date of Death Age If Veteran of U.S. Armed Forces,
06 / 12 / 2015 50 War or Dates 1982-1983
}- Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
iii
p Manner of Death®Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined "—I Pending
Iii CircumstancesInvestigation
ui Medical Certifier Name Title
CI
Address
giii Death Certificate Filed District Number Register 4tm�
iM City, Town or Village Saratoga Springs LL-�' 9
s 0Burial Date Cemetery or Crematory
06 / 15 / 2015 Pine View Crematory
Rlii ElEntombment Address
Cremation 21 Quaker Road, Queensbury, NY
a>> Date Place Removed
Z❑Removal and/or Held
and/or Address
E Hold
C Date Point of
1!)El Transportation Shipment
E by Common Destination
gi Carrier
3•
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
[s' Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Z.
Permission is h eby ranted to dispose of the human remai ri d ab 'ndicated
Date Issued Registrar of Vital Statistics
(signature)
District Number Li
5 Dif Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
til Date of Disposition 6/rrr/15' Place of Disposition gii/,,,, /7 ,,..
2 (address)
0
Cr (section) (loirnumber)r (grave number)
ciName of Sexton or Person in Charge of Premises /e. J
2 (p ase print) •
Ili Signature Lr Title
(over)
DOH-1555 (02/2004)