Foley, Brian NEW YORK STATE DEPARTMENT OF HEALTH - Burial - Transit-Permit
Vital Records Section
Middle Last Sex
Name First Foley Male
Brian
Date of Death Age If Veteran of U.S. Armed Forp0s,
April 15, 1999 48 War or Dates /��//
Place of Death Hospital, Institution or
City, Town or Village Street Address Saratoga Hospital
Manner of Death a Undetermined Pending
Natural Cause Accident Homicide Suicide Circumstances Investigation
Medical Certifier Name Title
Maurice B. O ' Connell MD.
Address 12 8 6 6
42 Myrtle Street, Saratoga Springs , New York, Re isterNumber
Death Certificate Filed District Number 9
City, Town or Village
Date Cemetery or Crematory
Burial April 19, 1999 Pine View Crematory
Address
QCremation Queensbury, New York, 12804
Date Place Removed
❑Removal and/or Held
... and/or Address
Hold
p Date ____TPoint of
N Q Transportation Shipment
by Common Destination
Carrier
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
. Registration Number
Permit Issued to
s. Name of Funeral Home wi lliam J. Burke & Sons Funeral Home 00269
Address
628 North Broadway, Saratoga Springs, New York, 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human re ain cribed v as i dicated.
Date Issued 4/16/99 Registrar of Vital Statistics
(si ' ature)
District Number
Place `SA 0GA SPRIN NY 12866
I certify that the remains of the decedent identified above were disposed of in accordance with this permiton:
g Date of Disposition /� 99 Place of Disposition
W. -7- (address)
UJI
(section) l lother) (grave number)
CName of Sexton r Person in Charge of Premises
� (please print)� �
Signature
Title d
(over)
DOH-1555 (9/98)