Sanchez, Cesar NEW YORK STATE DEPARTMENT OF HEALTH 4 f. It I C..)
Vital Records Section Burial - Transit Permit
. A
Name First Middle Last Sex
Cesar Sanchez Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 24, 2013 38 War or Dates
ZPlace of Death Hospital, Institution or
W City, Town or Village Kingsbury Street Address 22 Sue Lane
• Manner of Death 0 Natural Cause ❑ Accident El Homicide 0 Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
0
Marvin Davidowitz, M.D
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 5601 3 Z.r/
❑Burial Date Cemetery or Crematory
July 26, 2013 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
• and/or Address
E Hold
CO Date Point of
i0 El Transportation Shipment
01 by Common Destination
0' Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
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
F- Remains are Shipped, If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 712 / )3 Registrar of Vital Statistics CAD CAA4- ,Q. lw
(signature)
District Number 5601 Place 6 LQ"v,S F S,, # y
I— I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uDate of Disposition `7-Z°i-%1 Place of Disposition 'et..e,tL C"„cfi nt—.
W (address)
4 )(section (Iot number) (grave number)p Name of Sexton or Person • Charge of P ises `tf))'i1
Z'' (pl ase print)
W` Signature Title CO MA'rbi2
(over)
DOH-1555 (02/2004)