Sabo Jr, Nicholas ry vV YUKK STATE DEPARTMENT OF HEALTH # C7
Vital Records Section t Burial - Transit�ermit
Name First Middle Last Sex
Nicholas John Sabo Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 26, 2014 52 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address
. Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John P. Stoutenburg, Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Argyle 575- LI( P
❑Burial Date Cemetery or Crematory
October 27, 2014 Pine View Crematory
.❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
f-1 Removal and/or Held
LJ and/or Address
Hold
Date Point of
Transportation Shipment
trt by Common Destination
4 Carrier
Disinterment
Date Cemetery Address
,.
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St.,Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
F.; Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the huma em ins describ d ab e_as ind t .
Date Issued J y Registrar of Vital Statistics LC 1 �r
/0, �,�
(signature)
District Number 57 Place /2 JY1 CA
;r I certify that the remains of the decedent identified above were dispo ed of in accordance with this permit on:
< = Date of Disposition 10/27/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) 4 (lot number) (grave number)
Name of Sexton or Person iAn Charge of Premises
_ ( ease print)
/y.
Signature � Title CA to iliq
(over)
DOH-1555 (02/2004)