Schwed, Mark NEW YORK STATE DEPARTMENT OF HEALTH! * 41 11 K
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mark S Schwed Male
Date of Death Age If Veteran of U.S. Armed Forces,
10o/��20�4 75 War or Dates
- Place eat years-
Hospital, Institution $9 f} 63-1965
WCity, To Street( Saratog rings Street Address Ma
CI Manner o eatNatural Cause Li Accident 0 Homicide 0 SuiciderYittNF1etermined ❑Pending
Ili V
Circumstances Investigation
Q.
Medical Certifier Name Title
0
Adder Delmonte Jr. M D
377 Church Street, Saratn a Springs N Y 19866
Death Certificate Filed District Number Register Number
City, ToVX Saratoga Springs 4501 4`{
['Burial a-e Cemetery or Crematory
❑Entombment Address 0/13/2014 fine Vicw Cemetery
[ C;remation Queensbury N Y
Date Place Removed
g El Removal and/or Held
and/or
1-7 Address
Cl)
Hold
O Date Point of
N ❑Transportation Shipment
CZ by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue,Saratoga a.Springs, N Y 12866
>` Name of Funeral Firm Making Disposition old to Whom
.f4: Remains are Shipped, If Other than Above
Address
M.
II
it
Permission is hereby granted to dispose of the human rem ' cr. ed ab r indicat .
Date Issued 10/14/2014 Registrar of Vital Statistics
(signature)
District Number Place
4501 Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ,�+
ill Date of Disposition ro)i f/y Place of Disposition f Va,.., Cvr^s+ro„N,
2 (address)
la
Ul
ilk (section) dt.40-
jlot number) (grave number)
tt Name of Sexton or Person in Charge of Premises rn41
1Z lease print)
Signature 4 '�' ��'T— Title ►�l' `�
Y (over)
DOH-1555 (02/2004)