Hanafin, Michael f >T Z 3
NEW YORK STATE DEPARTMENT OF HEALTH
• Vital Records Section - Burial - Transit Permit
Name First Middle -st Sex
Michael C. Hanafin Male
>' Date of Death Age I If Veteran of U.S. Armed Forces,
03 / 19 / 2018 76 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Greenfield 1 Street Address 540 Locust Grove Road
a Manner of Death®Natural Cause El Accident E Homicide C Suicide 0 Undetermined ❑Pending
W. Circumstances Investigation
ili Medical Certifier Name Title
44 Gloria Ethier DO
Address
15 Maple Dell, Saratoga Springs, NY 12866
'i'iii Death Certificate Filed District Number Register Number
<. City,Town or Viiiage Greenfield
lili Burial Date Cemetery or Crematory
03 / 18 / 2018 Pine View Crematory
Entombment
Address
Cremation Queensbury, NY
Date Place Removed
a❑Removal and/or Held
and/or Address
ri: Hold
i
Date Point of
Q Transportation Shipment
by Common Destination
NO Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
igi Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
s>.{ Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above -
Address
it
ILI
Permission is hereby granted to dispose of the human re ains described above as indicated.
iii Date Issued •_ iq- I $ Registrar of Vital Statistics � `�` S . C: 10 �
(signature)
District Number LA 5) Place Greenfield , New York
Ai
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z, ;� 1,
la Date of Disposition 31/01Ig Place of Disposition T'.,Vim- ► i,
z (address)
ILI
CC (section) /(lot number) (grave number)
0 Name of Sexton or Person ip Charge o Premises i tc S.._-^�-
Z (pi se print) •
t Signature �" Title /6i► 1&
(over)
DOH-1555 (02/2004)