Azon, Glenn ># g3C7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Glenn Azon Male
Date of Death Age If Veteran of U.S.Armed Forces,
11 / 20 / 2015 59 War or Dates No
}- Place of Death Hospital, Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
a Manner of Death®Natural Cause E3 Accident Ej Homicide 0 Suicide riUndetermined ri Pending
Circumstances Investigation
Ili Medical Certifier Name Title
i
Address
Death Certificate Filed District Number Register Number
<:'. City,Town or Village Saratoga Springs
L„IBurial Date Cemetery or Crematory
li / 25/ 2015 Pine View Crematory
['Entombment Address
iiii:iipQCremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
Eu aHoldnd/or Address
CA
Date Point of
[l Transportation Shipment
by Common Destination
Carrier
iikilili 0 Disinterment Date Cemetery Address �.
»` Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
iiii!i.:: Name of Funeral Home Compassionate Funeral Care, Inc 00364
»'g Address
;> 402 Maple Ave., Saratoga Springs, NY 12866
gd Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
II Address
l
Permission is ereby granted to dispose of the human re s ted atria indicat
>< Date Issued j.1 n t i.s.---- Registrar of Vital Statistics
(signature)
District Number 45DI Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
21
ILI Date of Disposition II/26'()s Place of Disposition r I Crftrocrexi,-0-
31 {address)
fa
(section) Al (lot number) (grave number)
0 Name of Sexton or Person . Charge f Premises 14/1-i �1:"^
Z I (please print).
Signature l/ Title (wo t`r .
(over)
DOH-1555 (02/2004)