Baran Robert Lee # IZs2
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Lee Baran Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/02/2020 74 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death Le Natural Cause Accident El Homicide El Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Enrico Bravo MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 630
❑Burial Date Cemetery,Crematory or Facility Name
12/08/2020 Pine View Crematory
❑Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
- and/or and/or Held
~- Hold Address
0
d Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2020 Registrar of Vital Statistics join Paulranck(r karonicaQ Srgne4
(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:
Il— �
Date of Disposition Z/8/70 Place of Disposition `I '^-(�1,� f w1-dt
2 (address)
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CC CC (section) ff (lot number) (grave number)
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▪ Name of Sexton or Person in Charge of Pre es
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(ple se print)
!LSignature Title (ItICASITO
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) , ..{ 01 4 2 7 4
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#