Sabo, Stephen NEW YORK STATE DEPARTMENT OF HEALTH �,« r71 . 7
Vital Records Section ` Burial - Transit Permit
Name First Middle Last Sex
Stephen M. Sabo Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 14, 2013 58 War or Dates
Place of Death Hospital, Institution or
w. City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death v.urrl Natural Cause Accident Homicide SuicideILI
Undetermined Pending
C Circumstances Investigation
its,- Medical Certifier Name Title
Michael Fuller, M.D
I Address
102 Park St Glens Falls, NY 12801
Death Certificate Filed District Number,��� G Register Nu�mer
City, Town or Village ��"'
❑Burial Date Cemetery or Crematory
March 15, 2013 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
• and/or Address
—• Hold
C Date Point of
ci. 0 Transportation Shipment
O by Common Destination
Carrier
EjDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
Ct
Cc. Permission is he a granted to dispose of the human asiiinndica -d.
Date Issued (j J4 mains scribed ab ye
f3 Registrar of Vital Statistics �(j O_�a / / / p�j`�
n ' n ure)
District Number -.�� / Place .0 C�
I certify that the remains of the decedent identified above we e disposed of in accordance with this rmit on:
WDate of Disposition 3 18 I-3 Place of Disposition P�st/,�,,(,,f4,J Pam ,,,�y ,��
x_ (address)
Wi
I (section) /4t num er) (grave number)
0 Name of Sexton r Pe son i rge of Premises �. C ?�� l/tv'`� d
Z (please print)
iii
Signature Titled/ 45J`
(over)
DOH-1555 (02/2004)