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Guay, Joseph Emil w NEW YORK STATE DEPARTMENT OF HEALTH ) -t-• - Burial - Transit Permit Bureau of Vital Records rt Name First Middle Last Sex Joseph Emil Guay Male 4 Date of Death Age If Veteran of U.S.Armed Forces, 12/01/2020 50 Years War or Dates F' Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital O Manner of Death ©Natural Cause ❑Accident ❑Homicide 0 Suicide 1=1 Undetermined ❑Pending ILI Circumstances Investigation W Medical Certifier Name Title O 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 622 ❑Burial Date Cemetery,Crematory or Facility Name 12/10/2020 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Z n Date Place Removed O Removal and/or Held and/or Hold Address 0 d Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped,If Other than Above 2 Address CC W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2020 Registrar of Vital Statistics John Paul franck(ECectronicaltySigned) (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: 1-- Z Date of Disposition /t r✓l I 20 Place of -21 14.-- tif ,2 (address) IU 0 Charge (section) /J,r/ot nul ber y (grave number) O Name of Sexton or Person in of P ises C� Z (pteace print) W �_ Signature L-✓ � Title (y�'W,�4( -041 g DOH-1555(07/18)p 1 of 2 • Public Health Law Sec. 4145(2b) 014276 Receipt Human remains of delivered on , 20� Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Y`