Boodram, Bripnauth NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Bripnauth E. Boodram :::::......__ ...:. Male:::::::: :.
. ............:........:
Date of Death Age If Veteran of U.S. Armed Forces,
Au.gust.....3..,J 99.5... War or Dates ........
6.7:: _._
Z Place of Death Hospital, Institution or no:::::::.....:..
:U.t City Town or Village Street Address
S:c.h.uya.ex..u.z.l.l.e::. :. __.... -..... ....::-:.: .::::1.07....A.:..Or.e.e.n...:S.tr:e.e.t...
Q. Manner of Death
W ® Natural Cause � Accident ElHomicide � Suicide � Undetermined � Pendin9
Circumstances Investigation
..... ......:: ....... ....:.. _....:..:
Medical Cert'rfier Name Title
John Cetner Md ... __.....
. .. .
Address =
MyrtleStree,t., sarato.ga Springs., New York ..............................
Death Certificate Filed District Number Register Number
City,Town or Village SchuYlerville
Date Cemetery or Crematory
❑Burial August 7,.1995...... P:1ne.:.:View.:C.remator.y
x❑Cremation Address
Queensbury: :::NY .
z Date Place Removed
O_ ❑ Removal and/or Held
F- and/or Hold ..::::. ......::: __..::::. .
....:::: _: . :...........
Address
to
..
d Date Point of
cn ❑Transportation by Shipment
p` Common Carrier ........ --:::::. ... .::.,::,. _.. ::
Destination
❑ Disinterment Date Cemetery Address
........................... -:::::::
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm William J. Burke & Sons funeral Home 00267
.
Address
628 North Broadway, saratoga Springs, New york, 12866
.......
.4 Name of Funeral Firm Making Disposition or to Whom
�< Remains are Shipped, If Other than Above
. ....................................... ... .
Address
u�
._
Permission is hereby granted to dispose of the huma remains described above as indicated.
Date Issued 8/4/95 Registrar of Vital Statistics
(signature)
District Number �5 � Place Schuylerville , New York, 12871
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z> Date of Disposition Place of Disposition /� � .� 4J /t" /�,�'�/G'���14
u1 (address)
w
to (section) (lot number) (grave number)
tr
p Name of Sexton Person i Char a of Premi es
z (please print)
w Signature Title
........: ....... ................
DOH-1555 (10/89) p. 1 of 2 VS-61