Ogden Jr, Harold s I
NEW YORK STATE DEPARTMENT OF HEALTH , II #1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harold Ogden Jr. Male
giiii Date of Death Age If Veteran of U.S. Armed Forces,
04/30/2014 71 years War or Dates
Ii. Place of Death Hospital, Institution or
LLI
City, To 1CX J) XX(X Saratoga Springs Street Address Saratoga Hospital
• Manner of Death❑.Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined ElPending
10 Circumstances Investigation
itu Medical Certifier Name Title
C`ti Qiong Wang M D
Address
211 Church St., Saratoga Springs, New York
Death Certificate Filed District Number Register Number
City, ToJCXXVXJX (X Saratoga Springs 4501 209
El Burial Date Cemetery or Crematory
05/01/2014 Pine View Crematory
❑Entombment Address
['Cremation Queensbury, N Y
Date Place Removed
Z Removal and/or Held
RI—land/or Address
F= Hold
O Date Point of
�" Transportation Shipment
t�3
O by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
giii Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Springs, NY
gig Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
#e
III
Permission is hereby granted to dispose of the human remain.�
'be abo ' icated.
Date Issued 05/Q1/2014 Registrar of Vital Statistics V�R V^9A,
(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:
- C d
l� Date of Disposition ��Lff� Place of Disposition i,,t �,,, �,�,�,
(address)
Ill
CO
IX (section) (lot num r) (grave number)
G1 Name of Sexton or Person,in Charge of remises /4 IL, J _*
(please print)
S41 ignature G Title CrLu..71r rt
(over)
DOH-1555 (02/2004)