Steglik, John NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last Sex
John Steglik ..... IVale
>; Date of Death / Age ff Veteran of U.S.Armed Forces,
12 7/88 78 War or Dates No
Plf Death :, Hospital, Institution or
Z ace o eSarato a Springs Saratoga Hospital
ijo City,Town or Villag g g Street Address
iA1 Cause of Death
Respiatory Arrest
Medical Ceii rtifier Name Title
...... Brian J. Izzo YD
.....................................
Address
>«_ 35 Myrtle Street Saratoga Springs, NY 12866
..............................................:................... .................................................. r::::::..................
Death Certificate File District Number Register Number
City,Town or Village`�aratoga Springs 4501
Date Cemete pr Cremato
❑Burial December 8, 1988 Me Vie Crematorium
❑cremation Address
Town of Queensbury, NY
.......
2; Date Place Removed
Q ❑ Removal an Held
and/or Hold ::: :::::::::: ::::.............
Address
p, Date Point of
cn;; ❑Transportation by_. : Shipment
Common Carrier ...........
.. ...................................................
Destination
........................................ ...................................... ::::::. .....Address::::::...................................................................................................
..................................................................................................
❑ Disinterment Date Cemetery
....::::::..... .............::.::::.Ce mete:::::Address':::::.................................................:.................................................
❑ Reinterment Date ry
" Permit Issued to ; Registration Number
Name of Funeral Firm William J. Burke & Sons FH 00300
....................................................................................................t,..:.....::......::......::::::::::::...........:::::::::::::::::::::::::::::::::::::::::::::::::::>:::::::::::::::::::::::::::::::::::::::::::::::::::.::::::::::::
......................................................................................................................
Address
r> 6.2.8....N.orth....Broadwa :::::.:SDrings..�.::::��:Y::::�:2866:::::::::::::.:::::::::::::::::::.:..::::::::.
:: ::: : :: :: :::..::.:..::...:.... .. ..:........:. .. ..:.....:.. '..y._'..S:...... ga
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, R Other than Above
........
`.dG................:::......::....... ......:::::::::::::................................................................... ...........................................................................................................................
Address
'<<>
Permission is hereby granted to dispose of the human re is descried above, as Indicated.
12 8 8 8 --_
Date Issued Registrar of Vital Statistics
(signature)
<< District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
,p v h
Z< Date of Disposition 0-z '� Place of Disposition /
(address)
w
(section) (lot number) (grave number)
Ar
p; Name of Sexto or Perso Charge of Pre es L
tZ lease print)
Signature
DOH-1555(9/86)p 1 of 2(formerly VS-61)