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Hoetzel, Eric NEW YORK STATE DEPARTMENT OF HEALTH` ' . # "' Vital Records Section A Burial - Transit Permit Name First Middle last Se Eric Shawn oeltzel Male Date of Death Age - If Veteran of U.S. Armed Forces, 06/26/2013 49 years War or Dates 14 Place of Death Hospital, Institution or Z City, Dt101)6rX10110 Saratoga Springs Street Address Mary's Haven Ili ci Manner of Death j Natural Cause ElAccident ❑Homicide ❑Suicide ❑Undetermined ❑Pending ill Circumstances Investigation tu Medical Certifier Name Title C Joseph Dudeck MD Address 400 Patroon Creek Blvd., Suite 1, Albany, N Y 12206 Death Certificate Filed District Number Register Number '> City, TXLIWO6rXXIMAX Saratoga Springs 4501 274 «> ❑Burial Date Cemetery or Crematory 06/28/2013 Pine View Crematorium Entombment Address r::: ©Cremation Queensbury, N Y Date Place Removed Z Removal and/or Held 2 ❑and/or � Address to Hold 0 Date Point of 0 Li Transportation Shipment i by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Compassionate Care, Inc. 00364 Address 402 Maple Avenue, Saratoga Springs, N Y 12866 lill Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above Address Cr CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/28/2013 Registrar of Vital Statistics (signature il District Number 4501 Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I. ILI Date of Disposition 'TA-1-5 Place of Disposition ,,I,Umu) Crier-ct6ctv,•.. (address) Ili at CC (section) lot num er) /^ (grave number) Name of Sexton or Person in Charge of remises 1.4 . r 30iNtif (plea print) Signature �- - Title cilizoTre (over) DOH-1555 (02/2004)