Hagadorn, Karl W NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Male
Karl W.Hagadorn
Date of Death Age If Veteran of U.S.Armed Forces,
10/07/2022 88 Years War or Dates
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 Pending
W1-1Circumstances Investigation
W Medical Certifier Name Title
G 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 592
X Burial Date Cemetery,Crematory or Facility Name
10/12/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
0• Removal Date Place Removed
and/or and/or Held
- Hold Address
N
0
Date Point of
(/) Transportation Shipment
• by Common
Carrier Destination
111
Disinterment
Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500,Lake Luzerne,New York 12846
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/11/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(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:
I-
W Date of Disposition oh c a Place of Disposition . / / L.tokc2 R..1 �u CG05 r / w,/ J
2 (address) JJ
t!1 /3-e OC
cc N section/ tot number) (grave number)
0' Name of Sexton or Person in Charge of Premi es G %-v—"w7 c.3eCiCA'
Z (please print)
W Signature Aroci:it
..' Title ��e'i' t/) YlC/2
DOH-355(o7/18)p t of 2
Public Health Law Sec. 4145(2b)
U 12 947
Receipt
•
Human remains of delivered on , 20
>
Fine View Cemetery Representing the funeral home named on burial permit
/Official Funeral Directors Reg.or License#
HAGADORN
NAME Karl W. Hagadorn Age: 88
Lot Owner: Karl & Jean Hagadorn
Lot# Huron 1 3 C Grave# 2
Case: Concrete
Died: 1 0.7.2 2 Interred:1 0.1 2.2 2
Funeral Home: Brewer FH
Cemetery: Pine View