Scott, Edward NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edward J. Scott Male '
Date of Death Age If Veteran of U.S. Armed Forces,
July 17, 1998 74 War or Dates Air Force WW2
Place of Death Hospital, Institution or
City, Town or VillaRATOGA SPRINGS Street Address Saratoga hospital
Manner of Death 0 Natural Cause 0 Accident Q HomicideEl Suicide ElUndetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Rodney Ying MD.
Address
59 Myrtle St, SS, NY, 12866
Death Certificate Filed District�tJV 1j r Reg�12
City, Town or Village
Date Cemetery or Crematory
El Burial July 20, 1998 Pine View Crematory
Address
Cremation Queensbury, NY.
Date Place Removed
Z ❑Removal and/or Held
Hold
Q Date Point of
. Q Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral HomdJilliam J. Burke & Sons Funeral Home 00269
Address
628 North BroadwaY, Saratoga springs, NY, 12866
Name of Funeral Firm Making Disposition or to Whom
.. Remains are Shipped, If Other than Above
mo Address
Permission is hereby granted to dispose of the human repf ains°dg ribe b ve ated.
✓° r ''
"' Date Issued 7/20/98 Registrar of Vital Statistics a r' w
(signature
District Number
Place SARATOGA SPRINGS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f�-
WDate of Disposition Place of Disposition
(address)
UJI
n (section) m11 � (grave number)
Name of Sexto or Person in Charge of Premises
g (please print)W S i
Signature Title Q
DOH-1555 (10/89) p. 1 of 2 VS-61