Connair, Michael J. -11 73
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael J.Connair Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/01/2021 97 Years War or Dates Navy
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 156 Lawrence Street,Saratoga Springs,New York 12866
UJ
p Manner of Death 0 Natural Cause 0 Accident 1=1 Homicide Suicide ❑Undetermined ❑Pending
0 Circumstances Investigation
W Medical Certifier Name Title
G Christopher Thomas MD
Address
11 Hampstead Place,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 10
0 Burial Date Cemetery,Crematory or Facility Name
01/07/2021 Pine View Crematory
0 Entombment Address
ElCremation Queensbury,New York
❑Donation
0 ❑ Removal Date Place Removed
and/or and/or Held
NH Hold Address
O
d Date Point of
t/1 ❑Transportation Shipment
p by Common
Carrier Destination
0 Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped,If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/06/2021 Registrar of Vital Statistics join 2'aulTranckgYectronicalry 5011e4
(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
Date of Disposition I /Z Place of Disposition
W / (address)
W
N Q (section) 3 umber) (grave number)
gName of Sexton or Person in Charge of Premis ' l' 5C:A'Or'
Z (please pri t)
W Signature Title v 6fPV
DOH-1555(07/i8)p t of 2
Public Health Law Sec. 4145(2b) 014387
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#