Cooley, James It 26-,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name Fir t Middlest Se
ames Leonard Last Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/01/2013 73 years War or Dates
- Place of Death Hospital, Institution or
Z City, eking Saratoga Springs Street Address Saratoga Hospital
1A4Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
la Medical Certifier Name Title
L4 Desmond Del Giacco M D
Agr syrtle St, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, VCAVoinggitjii Saratoga Springs 4501 201
❑Burial Date Cemetery or Crematory
05/06/2013 Pine View Crematory
❑Entombment Address
E]Cremation Queensbury N Y .
Date Place Removed
Z❑Removal and/or Held
9 and/or Address
t Hold
O Date Point of
Transportation Shipment
a by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home .'=ompassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Ili
„" Permission is hereby granted to dispose of the human remains described above as indicated.
iE Date Issued 05/03/2013 Registrar of Vital Statistics trQfv-N —P- -4-otaft,A9k
(signature)
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:
k
iii Date of Disposition Place of Disposition
2 (address)
UI
to
cc (section) (lot number) (grave number)
CI• Name of Sexton or Person in Charge of Premises _
2 (please print)
iii
Signature Title
(over)
DOH-1555 (02/2004) '
- •14 f p.1
May 06 13 09:13a '
NEW YORK STATE DEPARTMENT OF HEALTH
Vita! Records Section Burial - Transit Permit
>s` Name Fir t Middl eLoare ID
ley Se male
Date of Death Age ' if V,`'-ran of U.S.Armed Forced ,
05101/2013 73;.ears War Dates
Place of Death Hospital, KIN-Lion or. fff
W City, 7,194.VoIXAKIO Saratoga Springs 1 Street Address �aratoaaa iospital
O Manner of Death Q Natural Cause D Accident Q Homicide Q Suicide Q Undetermined r Pending
IJt Circumstances Investigation
wa Medical Certifier Name Title
CI Desrnond Del Giacco N1 D
A ddie s .
9 lviyrtI St, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City,'> idoM Saratoga Springs 4501 201
[]Burial Date Cemetery or Crematory
05/06/20113 Pine View Crematory
`';❑Entombment Address
7 Cremation Queensbury N Y
Date ` Place Removed
°QRemoval _ and/or Held
and/or Address
it Hold
Eh
O Date Point of
Q Q Transportation _ Shipment
5 by Common Destination
Carrier
i'Q Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
• Name of Funeral Home .Compassionate Cara, Inc. 00264•
Address
402 Maple Avenue, Saratoga Springs, NI Y 12866
• Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
', . Address
liii
Permission is hereby granted to dispose of the human remainssiescribed above as indicated.
Date Issued 05/0312013 Registrar of Vital Statistics -7/Q,vn 4 d -,,.,,
(signature)
District Number 4501 Place Saratoga Springs
1 l certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition c t3 Place of Disposition eau) ert/netOr"--
(address)
ill
(section) lot number) ion
(grave number)
.`. Name of Sexton or Perso in Charge of remises Ar,y a'V
.e
Signature ( e print)Title COES1 CCK
(over)
DOH-1555 {02/2004)