Ferenczi, August Robert up ^ 35S
411.
NEW YORK STATE DEPARTMENT OF H EALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
August Robert Ferenczi Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/09/2022 77 Years War or Dates 1965-1967
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
`p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ElPending
U Circumstances Investigation
UJI G Medical Certifier Name Title
Scott Newton MD
•
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 293
Burial Date Cemetery,Crematory or Facility Name
05/10/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Fin
Removal Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
Cl) Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
�•. Remains are Shipped,If Other than Above
'; Address
CC
W
13' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/10/2022 Registrar of Vital Statistics Dillon Moran(ECectronicallySigned)
(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: (�
Z V,
Date of Disposition S 1 f t1 12 Place of Disposition
2 (a dress)
W
(section) � lot.number/ C\ (grave number)
SName of Sexton or Person in Charge Premises 1\t
Z ease print)
W Signature Title � ��
DOH-1555(07/18)p 1 of 2
1 Public Health Law Sec. 4145(2b)
01F 7f 1
Receipt
Human remains of delivered on _, 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#