Egan, James NEW YORK STATE DEPARTMENT OF HEALTH • II
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James Egan Male
Date of Death Age If Veteran of U.S. Armed Forces,
12 / 02 / 2015 71 War or Dates
}- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital
ILIa Manner of Death®Natural Cause Ej Accident Homicide 0 Suicide �Undetermined �Pending
U Circumstances Investigation
43
ta Medical Certifier Name Title
0 Rodney Ying MD
Address
59 Myrtle St # 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs
II Burial Date Cemetery or Crematory Pine View Crematory
12 / 04 / 2015
LI Entombment Address
ECremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
04
0 Date Point of
tilL Q Transportation Shipment
C by Common Destination
Carrier
iiiiii!iQ Disinterment Date Cemetery Address
Renterment Date Cemetery Address
iil
iligi Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
iiiiiii Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom _V u Kce& " w- e,ca t I-bm-2
.14 Remains are Shipped, If Other than Above
• Address
CC 1161 NI r\Viyt.s+, Eu 2 ti ave n t V ( b 5-743
iii
'' Permission is hereby granted to dispose of the human remai e ri ab°r - dicated
Nii
in Date Issued it9,14 "fl}ic Registrar of Vital Statistics I -
1 (signature)
Si District Number IrobjPlace Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
tf Date of Disposition j2.---)--t S Place of Disposition r t'n e c,,..e,,j C Piz.,Jar a ;�,,•i
2 (address)
La
Cr ( La /� (lot number) (grave number)
aName of Sexton or Person in Ch r e of Premises I t irif y 4Jrci, t(e
fir. F (please print)
LE[ Signature Title Cr4w,a /455/,
(over)
DOH-1555 (02/2004)