Hartman, Louis r , II
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Louis G. Hartman Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 1, 2012 93 War or Dates
.•.:a Place of Death Hospital, Institution or
' City, Town or Village Saratoga Springas Street Address Saratoga Hospital
cf; Manner of Death I Xi Natural Cause [ Accident I (Homicide Suicide I I Undetermined Pending
lam, Circumstances Investigation
L./ Medical Certifier Name Title
"q Alexander Cardiel MD
Address
211 Church Street,Saratoga Springs,NY 12866
:: Death Certificate Filed District Number Register Number
.:. City, Town or Village Saratoga 451
❑Burial Date Cemetery or Crematory
February 3, 2012 , Pine View Cremation
❑Entombment Address
El Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
OI I Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier _
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
6x ,
,-. Permit Issued to Registration Number
° 1 Name of Funeral Home Regan& Denny Funeral Home 01444
:1 Address
94 Saratoga Avenue, South Glens Falls,NY 12803
y Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
AO
Permission is hereby granted to dispose of the human rem . cr ed abo,v indica d.
,: Date Issued 021 31201 L. Registrar of Vital Statistics
(signature)
District Number 4-50 t Place Saratoga Seriv- �5l NN/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Place of Disposition �f r nr,V t Crtn.vior,u,.`
W Date of Disposition k 1p $ to�t p
2 I (address)
W
co
O (section) 4 (lot numbe (grave number)
p Name of Sexton or Person ' Charge of Pr mises 6 h:o14 r ohKt{-
Z (please print)
W Xl iS Title CQ tr ti l lo}-.
Signature ha
is.
DOH-1555(02/2004)