Reed, Michael NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael Reed Male
Date of Death Age If Veteran of U.S. Armed Forces,
Jan' 7 1997 40 War or Dates No.
Place of Death Hospital, Institution or
City, Town or Village Saratocla sprincls Street Address
Manner of Death ®Natural Cause Accident ❑Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
J. Paston MD.
Address
211 Church Street Saratoaa Sorinas , New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village S
aratocra SDrincrs 4501
Date Cemetery or Crematory
❑Burial Jan 1997 Pine View Crematory
®Cremation Address
Date Place Removed
0 Removal and/or Held
•— and/or Address
Hold
Q Date Point of
Q Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home William j.
Address
628 Nart-h Broadway . Spri New York., 12866
Name of Funeral Firm Making bisposition or to Whom
Remains are Shipped, If Other than Above
Address
Aw
Permission is hereby granted to dispose of the human remains'Zlbscr4ed above sin 'cated.
Date Issued 1/10/9 7 Registrar of Vital Statistics
(signature)
District Number 5� Place Saratoga Springs New York, 12866
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f�-
F Date of Disposition / — Place of Disposition f /{IV,F 1�/,F4f �,�"Mi97d�iL�Al
(address)
LU
X (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Imo` 41?p /0 1 l�
Z (please print)
Signature 51d"SbATitle ,
DOH-1555 (10/89) p. 1 of 2 VS-61