Reed, James — NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James Male
Date of Death Age If Veteran of U.S. Armed Forces,
Dece ber 25 , 1994 War or Dates nn
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address 12 Clubhouse
Manner of Death®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Dr. George Jolly Md.
Address
Death Certificate Filed istrict Number Register Numhar
City, Town or Village Saratoga Sprincls 450145
Date Cemetery or Crematory
El Burial December 28 , 1994 Pine View Cremator
Address
Cremation
ueensb r
Date Place Removed
0❑Removal and/or Held
•- and/or Address
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 Home William 00267
Address
628 North Broadway, Saratoga
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 rema' d c ed a e s ' d ated.
Date Issued 12/28/94 Registrar of Vital Statistics
(signature)
District Number 4501 Place _ Saratoga Springs,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 07 Place of Disposition/ W e-&EA1d7,0
(address)
UJI
W
(section) (lot number) (grave number)
0 Name of Sexto or Perso in Charge of Premises ,���/9�� ��,�
g (please print)
Signature Title77
DOH-1555 (10/89) p. 1 of 2 VS-61