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Benjamin, Frank
RX Date/Time 12/15/2017 1 ;12 15185844843 ( C 'f P.001 Dec. 15.2017 04 :37 PM COMPASZ3ION.!TE FUNERAL CAR 15185844843 PAGE. 1/ 1 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial w Transit Permit Name First Middle Last Sex IFrank Leland Benjamin Male g3 Date of Death Age if Veteran of U.S, Armed Forces, ' 12/14/2017 81 Years War or Dates 1953.1957 t,. Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Mary's Haven . • Manner of Death©Natural Cause []Accident []Homicide Suicide Undetermined ❑Pending ro Circumstances Investigation x ii Medical Certifier Name Title '; Rodney Ying MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 635 • ❑Burial Date Cemetery or Crematory 4. 12/15/2017 Pine View Crematory ,,, ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed ' c,i❑Removal and/or Held LL and/or Address ..1 Hold • Date Point of r❑Transportation Shipment 4., by Common Destination Carrier ?? Date Cemetery Address „ []Disinterment ry '� ; Reinterment Date Cemetery Address Permit Issued to Registration Number '�A Name of Funeral Home Compassionate Funeral Care Inc 00364 �' fit Address Nh 402 Maple Ave,Saratoga Springs,New York 12886 : j. Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address °4 Permission is hereby granted to dispose of the human remains described above as Indicated. `.. Date Issued 12/16/2017 Registrar of Vital Statistics yofinpoaeof, Vect uercalrystpncd r (signature) District Number 4501 Place Saratoga Springs, New York i^; 1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ri Date of Disposition i2bir? Place of Disposition isµj,, (..,.c/t,--- id (addres.) If ., (section) /lot number) ( (grave number) co ,n' Name of Sexton or Person in Charge of Premises L"L1_ .J''twilit a �� (plese print) A sm Signature /tcr- Title �'' — (over) DOH-1555(02/2004)