Sabo Sr, Antonius NEW YORK STATE DEPARTMENT OF HEAL{H, .% # 33
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Antonius Nicholas Sabo Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
b May 18, 2014 86 War or Dates
Place of Death Hospital, Institution or
Z`" Ci
LLlty, Town or Village Kingsbury Street Address
CI,
Manner of Death mu Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ri❑ Pending
LLI
Circumstances Investigation
W Medical Certifier Name Title
Ch William Borgos,
Address
161 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
May 23, 2014 Pine View Cemetery
❑Entombment Address
a. ®Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
p. Hold SARATOGA NATIONAL
0) Date Point of GtMtTERY
0= Transportation Shipment
by Common Destination
Carrier
❑ Disinterment
Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
X
W
Ct.' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued c-jam-.1 a y Registrar of Vital Statistics C. ii-t,,t_,;(:,.
-., ; (signature)
District Number 5-- 7 6 L Place Trii,—,, 5 /t' 4._.ti
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W; Date of Disposition 05/23/2014 Place of Disposition Quaker Rd. Queensbury,NY 12804
(address)
W
le (section) (lot number (grave number)
0 ti
d Name of Sexton or Pers in Charge of Premises r P„N
f� lease print)
U i *+Signature ta.. 4+�1"-• Title CIZEW
(over)
DOH-1555 (02/2004)