Gailor, George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
<' Name First Middle Last Sex
George Gailor
':i Date of Death Age If Veteran of U.S. Armed Forces,
09 / 23 / 2015 44 War or Dates N/A
Place of Death Hospital, Institution or
Z City, Town or Village Wilton Street Address 17 Newington Ave.
pManner of Death®Natural Cause 0 Accident 0Homicide E Suicide �Undetermined 0 Pending
II Circumstances Investigation
Ill Medical Certifier Name Title
Michael Sikirica MD
Address
50 Broad St, Waterford, NY 12188
Death Certificate Filed District Number Register Number
City, Town or Village Wilton
ii:ArlBurial Date Cemetery or Crematory
09 / 28 / 2015 Pine View Crematory
i▪ f Entombment Address
?uNCremation 21 Quaker Road, Queensbury, NY
Date Place Removed
1 0 Removal and/or Held
and/or Address
t Hold
aen Date Point of
[]Transportation Shipment
by Common Destination
iim Carrier
Q Disinterment Date Cemetery Address
[]Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
`» Address
402 Maple Ave. , Saratoga Springs, NY 12866
ili
<> Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
f
: ` Permission is hereby granted to dispose of the human remains described above as indicated.
Oi
Date Issued Registrar of Vital Statistics a,1_ t''jc
(signature)
District Number /:15 Log Place Wilton , New York
Lgii I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k.
Date of Disposition l'Lt/Ic Place of Disposition ti,N,tL c cc&_
(address)
ILI
VI
a (section) (lot number) (grave number)
C Name of Sexton or Person in Charge of Premises
' (please print)
114 4
Signature Title r4 i IL
(over)
DOH-1555 (02/2004)