Hegninian, Zohrab . mit if 3)3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Zohrab O. Heghinian Male
Date of Death Age If Veteran of U.S. Armed Forces,
04/25/2015 80 years War or Dates
Place of Death Hospital, Institution or
5Town 01):4000Z Clifton Park Street Address 51 Stoney Creek Drive
a Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
LLJ Circumstances Investigation
Ili Medical Certifier Name Title
Michael Sikirica Medical Fxaminer
Address
50 Broad St., Waterford, N Y 12188
Death Certificate Filed District Number Register Number
;;:Town or)601XX Clifton Park 4552 41
❑Burial Date Cemetery or Crematory
❑Entombment 04/28/2015 Pine View Crematory
Address
Cremation ( ueensbury, N Y
s . . Gate Place Removed *' ,.. ,
Z ri❑Removal and/or Held
and/or Address
= Hold
tiff
0 Date Point of
114❑Transportation Shipment
G' by Common _ Destination
Carrier -
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
p. Permit Issued to Registration Number
Name.of Funeral Home Compassionate Funeral Care 00364
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 Addressit
ILI
` Permission is hereby granted to dispose of the human r ains described abo e as indicated.
Date Issued 04/27/2015 Registrar of Vital Statistics 1_, 0 01
I) 0
(signature)
District Number Place
4552 Clifton Park
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition 4/'NiIS Place of Disposition ."4, , ( 0-, -
2 ' (address)
L
ta
j - (section) // (lot number) - (grave number)
aName of Sexton or Person in Charge of Premises tcrt+At_ St^M
z
e (please print)
t iq Signature Title (RibilATe;ti
(over)
DOH-1555 (02/2004)