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Shannon, Joseph NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joseph J. Shannon Male Date of Death Age If Veteran of U.S. Armed Forces, 07/14/2014 51 years War or Dates 2/83-12/83 I- Place of Death Hospital, Institution or Fu City, TgCXXXg(r YAW Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause n Accident El Homicide El Suicide ElUndetermined El Pending Circumstances Investigation ill Medical Certifier Name Title e5 J Robert Hayes M.D. Address 211 Church Street Saratoga Springs, N. Y. 12866 Death Certificate Filed District Number Register Number City, TgMQX0(r kiiMIX Saratoga Springs 4501 325 ❑Burial Date Cemetery or Crematory ❑Entombment 07/16/2014 Pineview Crematorium Address ©Cremation Queensbury N Y Date Place Removed Z❑Removal and/or Held C1 and/or Address 1:: Hold an 0 Date Point of Transportation Shipment G by Common Destination • Carrier El Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address . Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address P. O. Box 277, Fort Ann, N Y 12827 • Name of Funeral Firm Making Disposition or to Whom • _ Remains are Shipped, If Other than Above Address US- CL .: Permission is hereby granted to dispose of the human remai ri d abD 'ndicate Date Issued 07/15/2014 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i f Date of Disposition `)-ih-(y Place of Disposition -1 tntuow �r-10t w (address) ILI CC (section) (lot number) c (grave number) ci Name of Sexton or Person in Charge of Premises /111,e,..- "Nit l ( se print) Signature Zit .41` - Title Gi2tP1fL (over) DOH-1555 (02/2004)