Cute, Bernard NEW YORK STATE DEPARTMENT OF HEALTH 4/1 ��S--
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
8eCa✓d Cote
Date of Death Age If Veteran of U.S. Armed Forces,
/O 1,72 /J( 3 st War or Dates J 9143 - /94/5
1.....iPlace of Death Hospital, Institution or ,/� /
W City, Town or Village S6I,e/i qa sp1 N9p Street Address ,�2 5CL r% ,l/
Q Manner of Death❑Natural Came ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending
Circumstances Investigation
ta Medical Certifier Name Title
.0 .i- ,fi0 MOO
ail 0/ 1 ch gi-
Death Certificate Filed District Number Register Number
Gown or Village SARATOGA SPRINGS 51 D/
❑Burial Date/ Cemetery or/Cremato y�
❑Entombment � ����C�( p//Z Viet° ( /2l�ry
Addres
emation 1 HActUPP RA Oukchiovi,/,) 1 y / 2 aY
Date Place Removed
Z❑Removal and/or Held
and/or Address
LC
Hold
0 Date Point of
ti❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration umber
Name of Funeral Home 0P/)0J-3/6) (4 litizo-ay( Cai- (26,??
AdLOd
ss
rn ,ate cato SQL � . Sp Li( /28 le&
Name of Funeral Fi m Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2 Address
CC
d` Permission is hereby granted to dispose of the human remains ibe above s indicated.
Date Issued I0 2i/2.013 Registrar of Vital Statistics t -
(signature)
District Number /5/ Place SARATOGA SPRINGS
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ttl Date of Disposition 10 II3o113 Place of Disposition 't,ntVa4 +06v,...
2 (address)
W
in
CC (section) (lot number) c (grave number)
CI Name of Sexton or Per n in Charg of Premises 1,#"ipL ` ona/`r
z (please print)
Signature Title Ct1,I-M1'iia
(over)
DOH-1555 (02/2004)