Graham, Bryan t .. E fiw-ii
NEW YORK STATE DEPARTMENT OF I ALTH *`
Vital Records Section Burial - Transit Permit
Name First , Middle Last Sex
Bryan Graham Male
Date of Death Age If Veteran of U.S. Armed Forces,
08 / 23 / 2018 62 War or Dates N/A
}- Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs, NY Street Address 335 Jefferson Street, Lot A3
a Manner of Death LE Natural Cause ❑Accident Homicide 0 Suicide Undetermined 7 Pending
Circumstances Investigation
tu Medical Certifier Name Title
Q Muhammad Tai MD
Address
896 Riverview Rd Rexford, NY 12148
giiii Death Certificate Filed District Number / Register Nu r
! City, Town or Village Saratoga Springs, NY
;;;;nBUflal Date Cemetery 08 / 24 / 2018 or Crematory
ElEntombment Pine View Crematory
Address
Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address
0 Hold
CA
gi Date Point of
Q Transportation Shipment
O by Common Destination
lig Carrier
` ` Disinterment Date Cemetery Address
i'iQ Reinterment Date Cemetery Address
i',
iliiiii Permit Issued to ; Registration Number
Name of Funeral Home Compassionate Funeral Care 1 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
ikii!i Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z. Address
"" Permission is h reby ranted to dispose of the human remai so' ed ab ve a indicated.
Date Issued 7 Registrar of Vital Statistics
(signature)
District Number y 5 1 Place Saratoga Springs, NY , New York
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
til Date of Disposition-drq-t Place of Disposition P are, i ti w G!'t,,,ch;'y
2 (address)
Ili
er (section) (lot number) (grave number)
a Name of Sexton or Person 41 Charge of Premises
z (please print) .
Signature ` Title Grw mG.}v r
(over)
DOH-1555 (02/2004)