Maki, Michael E ir1
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael E Maki Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/04/2021 51 Years War or Dates
ZZ Place of Death Hospital,Institution or
UJ
City,Town or Village Saratoga Springs Street Address 40 B Allen Drive,Saratoga Springs,New York 12866
p Manner of Death El Natural Cause 11 Accident Ei Homicide 11 Suicide 0 Undetermined ❑Pending
W C.) Circumstances Investigation
ILI Medical Certifier Name Title
CI
Claudina Ashelman NP
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 125
0 Burial Date Cemetery,Crematory or Facility Name
02/06/2021 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
0 0 Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
d Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
IDDisinterment Date Cemetery Address
ElReinterment 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
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/05/2021 Registrar of Vital Statistics join c2'aulfranck(Ekaronica(4pee9
(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:
F— j
Z Date of Disposition 2 if f ZI Place of Disposition 4. .,q., 4Or‘..,_
2 (address)
W
Cl)
CC (section) of number) (grave number)
0 Name of Sexton or Person in Charge of Prerrj es t.I t 4nMEi
Z (pteast)
W Signature
g Title I03illr
..."
DOH-1555 lo7/18)p 1 of 2
1
Public Health Law Sec. 4145(2b) )14,599 I
Receipt
1," i
Human remains of ' delivered on , 20
s
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#