Goetz, Joseph \�
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Pe mit
Name First Middle Last Sex
Joseph Goetz Male
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 27 / 2018 84 War or Dates N/A
1 Place of Death Hospital, Institution or
Z City, Town or Village Fort Edward Street Address 29 Seminary Street
ctManner of Death®Natural Cause 0 Accident Homicide Suicide ❑Undetermined 0 Pending
Circumstances Investigation
0.
at Medical Certifier Name Title
William Borgos MD
Address
161 Carey Rd bldg 1, Queensbury, NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5 t1 J 5 , '
>'> ElBurial Date Cemetery or Crematory
10 / 29 / 2018 Pine View Crematory
'' ' Entombment Address
Ni m
} niCremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
w
Date Point of
Q Transportation Shipment
by Common Destination
iN Carrier
imi
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
CC
IP
vii
:, Permission is hereby granted to dispose of the human remains described�� above as' dicated.
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iei Date Issued I oI3o v Registrar of Vital Statistics T, /lam V CYZ�I .
d_____,
J_ _ (signature)
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IX ii District Number r;riss Place Fort Edward , New York
': I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Date of Disposition /0(3t 119 Place of Disposition N U ✓ r,�, n
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(address)
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fn-
a (section) (lot numbl) (grave number)
0 Name of Sexton or Person ill Charge of Premises . G r% w,•141
Z . (please print) •
Signature a Title iIfM
(over)
DOH-1555 (02/2004)