Koss, Raymond Mar.23.2018 03:39 PM COMPASSIONATF,. FU5 RAL CAR 15185844843 PAGE. 1/ 1
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
3 Name First Middle Last Sex
s e?, Raymond Francis Koss Male
i . Date of.Death Age if Veteran of U.S:,,Armed.Forces,. , •
1 03/2112018 BB Years War or.Dates 1951-1953
' Place of Death Hospital, Institution or
I„_City, Town or Village seratoga Springs Street Address.Saratoga Hospital
Manner of Death Natural Cause ❑Accident Homicide Q Suicide ❑Undetermined Pending '
i Circumstances Investigation
't Medical Certifier Name Title
'"' .. Mark Weidner , MO
• . • Address
•
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4801 178 •
❑Btariai ' Date Cemetery or Crematory
03/23/2018 Pine View Crematory
❑Entombment Address '
®Cremation Queenabury Town, Now York
`if. 'Date ace Removed: . '
`.. Removal id/or Held
z' and/or Address
'I,
Hold r
Date I Point of
• 0 Transportation l Shipment
by Common Destination
,I Carrier
; 0 Disinterment • Date- , Cemetery Address
'f Date Cemetery Address
• Li Reinterment
Permit Issued to Registration Number
.,
� Name of Funeral Home Compassionate Funeral Care Inc 00364
' + Address
IL 402 Maple Ave,Saratoga Springs,Now York 12888
'(' Name•of Funeral Firm'Making Disposition•or to Whom,
':, Remains are Shipped, If Other than Above
Address
ill
Permission Is hereby granted to dispose of the human remains described above as indicated.
.`, Date Issued 03/2312018 Registrar of Vital Statistics Mtn4P Franck,(►E&ctrunicairyStAttad)
;, , (signature)
1 District Number 4601 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
G Date of Disposition 3)11 II I Place of Disposition &V.., �>�vA o---
-I
(address)
1N
7',
(section) // (lot number)r- (grave number)
Name of Sexton or Person In Charge of Premises t-} , 441.
(phlese print)
fi Title l�6Mr1 ryrt
Signature "i ,
(over)
DOH-1555(02/2004)