Gabriel, John NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First John Middle W. Last Gabriel Sex Male
'< Date of Death Age If Veteran of U.S. Armed Forces,
10/5/97 67 War or Dates Korean War
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address DOA Saratoga Hospital
F. Manner of Death Natural Cause Accident ❑Homicide Suicide ❑Undetermined Pending
Certifier Title Circumstances Investigation
Medical Cerer Name
Jack Paston MD
Address
Sarato a S rings NY
Death Certificate Filed District Number Reg' teer3Number
xxx
City, Town or Village Saratoga SpringsA.
Date Cemetery or Crematory
UBurial 10/7/97 Pine View Crematory
Address
OCremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
y.• and/or Address
Hold
Date Point of
Transportation Shipment
G by Common Destination
Carrier
.Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Harris Funeral Home 00872
Address
Railroad Avenue Roscoe, NY 12776
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other.than Above
Address
Permission is hereby gpnted to dispose of the hum remai escribe ab v as indicated.
Date Issued 1 /7/°7, Registrar of Vital Statisti s
( gnature)
Place
District Number
Saratoga Springs, NY, 12866
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
! f /
W Date of Dispositior�� Place of Disposition �//yam Y/.F0 C/r.c/r/ rM/ �—
(address)
LU
(section) (lot number) > (grave number)
Name of Sexto or Person in Charge of Premises .457-Mf IF17 ,l 12�/� YJ
a (please print) ►
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61