Savage, Todd Michael cl—
NEW YORK STATE DEPARTMENT OF HEALTH , ./
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Todd Michael Savage Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/29/2022 58 Years War or Dates Navy
1— Place of Death Hospital,Institution or
Z City,Town or Village Fort Ann Town Street Address 277 Clay Hill r do, 'ort Ann Town,New York 12827
'p Manner of Death ❑X Natural Cause Accident []Homicide OSuicide lUndetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
a Paul Bachman MD
Address
9 Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed Town Of Fort Ann District Number Register Number
City,Town or Village 5754 19
▪Burial Date Cemetery,Crematory or Facility Name
09/30/2022 Pine View Crematory
Address
Cremation Queensbury Town,New York
▪Donation
o❑Removal Date Place Removed
and/or and/or Held
- Hold Address
N
0
d Date Point of
UN Transportation
' by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
a Address
lW
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/30/2022 Registrar of Vital Statistics Jenniferyackson(E(ectronicat ySigned)
(signature)
District Number 5754 Place Town Of Fort Ann
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition /i` --/'Z Z Place of Disposition , O e l � Ef.� (rW-7414.4 t'
2 (address)
lW
CC (section) (lot num er) (grave number)
1 Name of Sexton or Person in Cha of Prem. s 1� 7►�0•1‘;� ( �
Z (please print/
W Signatures l Title �/K�g
DOH-1555(07/18)p t of 2
• 1 ti` f,2c
{
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#