Savitz, Simeon NEW YORK STATE DEPARTMENT OF HEALTH IU1i
Vital Records Section .- % Burial - Transit Permit
Name First Middle Last Sex
Simeon Savitz Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 16, 2012 84 War or Dates
t~- Place of Death Hospital, Institution or
;Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death ✓ Natural Cause Accident n Homicide Suicide Undetermined Pending
U1 Circumstances Investigation
w Medical Certifier Name Title
0 �-_, osep�( C pi 4I1bu ML . —
Address-20 Ptca -A Si-. qt , �y. 17,364
fi District Number Register Number
: Death Certificate Filed g
City, Town or Village Glens Falls 5601 l
-,
❑Burial Date Cemetery or Crematory
February 20, 2012 Pine View Crematorium
❑Entombment Address
®Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
H and/or Address
N Hold
0 a. Date Point of
WI I Transportation Shipment
c by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to ! Registratio~er
Name of Funeral Home Regan& Denny Funeral Home
53rirom
ualcer Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
1. Remains are Shipped, If Other than Above
2 Address
Permission is herranted to dispose of the human emains describe above as in„icate•.
e by p
Date Issued ,e3c9 egistrar of Vital Statistics 67 ...(L.,0-L ,,/ ,. a(2)"L
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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w f.Date of Disposition 2 L 7O Place of Disposition ,�bwJ Co �cft,_
2 1 (address)
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CL (section) (lot nu�r) (grave number)
o Name of Sexton or Pers n in Charg of P_ remises ` � }(,, �- J 1,4k-
Z (please print)
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Signature Title aE.m -reit
(over)
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