Saxton, Edward NEW YORK STATE DEPARTMENT OF HEALTH, * /1 372,
Vital Records Section Burial - Transit Permit
Name First Middle Last Se
Edward Saxton Male
ii Date of Death Age If Veteran of U.S. Armed Forces,
iib 07/01/2013 90 years War or Dates 1938-1939
j- Place of Death Hospital, Institution or
City, 1XXXX MIX Saratoga Springs Street Address 8 Martin Avenue, Saratoga Springs, N Y
14,1
Ct Manner of Death 0 Natural Cause El Accident El Homicide ❑Suicide El Undetermined ri❑Pending
Ltd Circumstances Investigation
tit Medical Certifier Name Title
0 David M. Mastrianni MD
Address
3 Care Lane, Suite 300, Saratoga Springs, Ny 12866
iiiiU Death Certificate Filed District Number Register Number
City, -01550)OrMailIK Saratoga Springs 4501 278
❑Burial Date Cemetery or Crematory
❑Entombment 07/03/2013 Pine View Crematory
Address
®Cremation Queensbury N Y
Date Place Removed
Z Removal and/or Held
❑and/or
i ' Address
U)
Hold
0 Date Point of
to Li Transportation Shipment
L by Common Destination
Carrier
a ElDisinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
o
im 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
Remains are Shipped, If Other than Above
2 Address
it
Lu
Permission is hereby granted to dispose of the human remains rib above-as • dicated
iia Date Issued 07/03/2013 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:
k � ��
ILI Date of Disposition T,Place of Disposition ,y0«w d�'(j.
2 (address)
Ili
CO
CC (section) I (loumber) crit (grave number)
Name of Sexton or Person in Ch rge of Premises .(,< t n
(ple se print)
14
iiiaSignature Title C Q 'tM -Idit
(over)
DOH-1555 (02/2004)