Waage, Jeffrey J r r ...,4„35
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jeffrey J.Waage Male
::`: Date of Death Age If Veteran of U.S.Armed Forces,
51 04/23/2022 72 Years War or Dates
F Place of Death Hospital,Institution or
City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
WI
p Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined ri Pending
0 Circumstances Investigation
ILL Medical Certifier Name Title
Rick Teetz MD
„y_ Address
t. 131 Lawrence St,Saratoga Springs,New York 12866
• Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 262
RBurial Date Cemetery,Crematory or Facility Name
04/26/2022 Pine ViewCrematory
Entombment Address
• Cremation Queensbury Town,New York
- S 0 Donation
e IIIRemoval Date Place Removed
and/or and/or Held
N
Hold Address
0
C Date Point of
U)['Transportation
5 by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
` ]Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
1= Name of Funeral Firm Making Disposition or to Whom
F* Remains are Shipped,If Other than Above
g Address
CC
1U
a' Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued 04/25/2022 Registrar of Vital Statistics (DillonMoran(E(ectronwallySigned)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Date of Disposition y ZV(it Place of Disposition
RA,.._ of jCud...._
2 (address)
W
CC (section) (lot number) u (grave number)
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Og ./.1✓i i1,/l�
Name of Sexton or Person in Charge of emises ('► �Q
0 //pease print) /�
Signature Title G FA CV(
DOH-1555(o7/18)p 1 of 2
nt
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#