Barody, Clifford NEW YORK STATE DEPARTMENT OF HEALTH O 11,-)
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Clifford Earl Barody Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/10/2014 72 years War or Dates
1- Place of Death Hospital, Institution or
Z City, Tow )/iIXX Glens Falls Street Address Glens Falls Hospital
0 Manner of Death❑aatural Cause 0 Accident D Homicide 0 Suicide riUndetermined 0 Pending
lU Circumstances Investigation
W Medical Certifier Name Title
John P Stauterburg M D
Address
102 Park Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, Tow /iIXX Glens Falls 5601 116
❑Burial Date Cemetery or Crematory
❑Entombment 03/12/2014 Pine View Crematorium
Address
❑cremation Queensbury, NY 12804
Date Place Removed
CZ❑Removal and/or Held
2 and/or Address
M Hold
IA
0 Date Point of
3
Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address .
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
;` Address
402 Maple Street Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
IU
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/11/2014 Registrar of Vital Statistics C3cLA. - s. ,0.,\- . )
(sig attire)
District Number Place
5601 Glens Falls)
I certify that the remains of the decedent identified above were disposed of in acc rdance with this permit on:
W. 3-/3 Date of Disposition 7V Place of Disposition ,�N6 4.4./ 1 0�,G,l�
(address)
ILI
CC (section) (lot number) (grave number)
2 /Name of Sexton 5:1 P s in Charge of Premises
Z �i / (please rIn_t)/
141. Signature ! 1 Title C /L �i/157
(over)
DOH-1555 (02/2004)