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Pravda, Thomas NEW YORK STATE DEPARTMENT OF HEALTH �� �� Vital Records Section _ Burial - Transit Permit Name FirstMiddle Last Sex homas Vincent Pravda Male Date of Death Age If Veteran of U.S. Armed Forces, 11/10/2013 51 years War or Dates 1—. Place of Death Hospital, Institution or Z gPOTown or IELVX Town of Saratoga Street Address Rt. 9P 14.1 Manner of Death D Natural Cause Accident D Homicide D Suicide ElUndetermined D Pending W Circumstances Investigation tu Medical Certifier Name Title Susan Hayes MMA/Coroner Address 579 Grand Ave., Saratoga Springs, NY 12866 Death Certificate Filed District Number .Register Number iSiAXI'own or WI( Town of Saratoga 4565 10 ! ' OBurial Date Cemetery or Crematory 11/18/2013 Park View Crematory DEntombment Address [►'Cremation Queensbury, NY Date Place Removed Z Removal and/or Held El _ i Address co Hold Date Point of 2L0 Transportation Shipment 0 by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care 00364 Address 402 Maple Ave., Saratoga Springs, NY <_ Name of Funeral Firm Making Disposition or to Whom ; Remains are Shipped, If Other than Above Address CC Ili fl' Permission is hereby granted to dispose of the human remains described above as indicated. 1.1 Date.Issued 11/13/2013 Registrar of Vital Statistics Cj,.,t cif'L c (), (signature) District Number 4565 Place Town of Saratoga " I certify that the remains of the decedent identified above re disposed of in accordance with this permit on: ri 7 VA4,/ LU Date of Disposition/1/7,/2 Place of Disposition ii CeZe,,/,04,V (address) ili U (section) �f (lot number) (grave number) Name of Sexton P rso Ct. . rge of Premises `3� 7/ (lot g. ca© (please print)"c II Yri Signature Title ‘t- , (over) DOH-1555 (02/2004)