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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