Laura, Raymond NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Raymond Laura Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/05/2020 88 Years War or Dates 1951-1954
F 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
W Circumstances Investigation
U
W Medical Certifier Name Title
Scott Newton MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 13
❑Burial Date Cemetery,Crematory or Facility Name
01/07/2020 Pine View Crematory
Entombment Address
)C Cremation Queensbury,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
F—CO) Hold Address
O
d Date Point of
CO) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
i
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
�.- Remains are Shipped,If Other than Above
Address
it
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/07/2020 Registrar of Vital Statistics .7olen PPaulTranck(Electro-kad Stgued
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 4 I t0 Place of Disposition
LU (address/
W
N (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises 4— l
Please print)
Z
W Signature Title
I
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) Q 1 3 2 1 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#