Merrills Sr., Thomas W. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas W.Merrills Sr. ---7Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/08/2020 76 Years Waror Dates 1961-1963
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death RiNatural Cause Accident Homicide Suicide Undetermined Pending
UCircumstances Investigation
WW Medical Certifier Name Title
113 Carlos Ares MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 158
Burial Date Cemetery,Crematory or Facility Name
03/14/2020 Pine View Crematory
Entombment Address
K]Cremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
~CO) Hold Address
O
IZ Date TIPoint 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 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
E— 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 03/13/2020 Registrar of Vital Statistics -7mf-Paul!'ranc,E(EfectronicaQ Signed)
(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:
H
Z Date of Disposition J:L . .4z3 Place of Disposition
W '
2 addre�/
W
Ir (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premi E
Z —� (purse pant)
W Signature Titlejr
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0)I',;;4 e_
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#