Kinsella, John D. r ..�c/
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John D. Kinsella
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 23 / 2020 83 War or Dates
Place eath Hospital, Institution or
Ci ow or Village Ballston Street Address 343 Moonlight Drive
p Manner of Death ENatural Cause ❑Accident 0 Homicide Suicide Undetermined El Pending
ll Circumstances Investigation
Medical Certifier Name Title
too Lt
A res #� �l I `l� lc��
r
Death Certificate Filed District Nu m Register Number
City, or Village Ballston
ow li
OBUflal Date Cemetery or Crematory
O1 / 24 / 2020 Pine View Crematory
i '[]Entombment Address
Cremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human re sins deVrilked allpova in icated
Date Issued Registrar of Vital Statistics
signature)
District Number—y,( Place Ballston , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1, Date of Disposition -,��-zvzp Place of Disposition (�,' (/,`
(addres
0. (section) (lot nu m er) (grave number)
Name of Sexton or Pers in Charge f Premises �1 ►4�is1�1.r�
� (please print) .
Signature Title /M r
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) a 1 ' :✓7 4
1
Receipt
Human remains of ' E - delivered on , 20--
Pine View Cemetery,r Reprenfing the funeral home named yn burial permit
Official Funeral Directors Reg.or License#-r? 4"