Grotto, Ralph 4tL3)NEW YORK STATE DEPARTMENT OF HEALThL ;
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ralph L. Grotto Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/07/2014 93 years War or Dates
f- Place of Death Hospital, Institution or
6 City, ToIKRXrXVAAIRX Saratoga S rings Street Address Sarato a Hospital
p Manner of Death 1 watural Cause Accident Homicide ❑Suicide Li Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
Q Carlos A ArPs Md
Address
59 Myrtle St., Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, Toq(C70(574190( Saratoga Springs 4501 450
OBurial Date Cemetery or Crematory
Entombment 10/09/2014 Pineview Crematory
Address
Eremation Queensbury. N Y
Date Place Removed
Z❑Removal and/or Held
and/or Address
imik Hold
CA
0 Date Point of
CL
Q Transportation Shipment
0 by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
. TiPermit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
Name of Funeral Firm Making Disposition or to Whom
.1 Remains are Shipped, If Other than Above
Address
tr
tu
ri;` Permission is hereby granted to dispose of the human remai desc 'b abdfa r dicated
•
Date Issued 10/08/2014 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iii Date of Disposition (0 Ai iq Place of Disposition ,F41)ic.1 L wv'j'a�
(address)
W
11 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises /At► .58.E
2ease print)
Signature /1 Title Cath
i (over)
DOH-1555 (02/2004)