Holmes, Richard N. #''
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard N.Holmes Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/15/2020 78 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Mannerof Death Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
U
WD Medical Certifier Name Title
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 114
Burial Date Cemetery,Crematory or Facility Name
02/18/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation "
Z Removal Date Place Removed
0 and/or and/or Held
U) Hold Address
O
(L Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 100364
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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/18/2020 Registrar of Vital Statistics .70&PaulFFh--,((EkctronicaQ So-d)
(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:
n
Z Date of Disposition J7, I Zc7 Place of Disposition t �,, L/ t 1�
W
2 (address)
W
N
X (section) blot number - (grave number)
aName of Sexton or Person in Charge of Pre ises Cat-
Z (p/ se print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of %' S delivered on ' , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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