Perkins, Wiliam Harold # Z I$
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Harold Perkins Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/09/2020 73 Years War or Dates 1965-1968
Place of Death Hosdltal,Institution or
WCity,Town or Village Saratoga Springs Streit Address Saratoga Hospital
p Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
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 147
Burial Date Cemetery,Crematory or Facility Name
03/10/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
d Date Point of
N Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
t Reintermen 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
f.. Remains are Shipped,If Other than Above
Address
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/10/2020 Registrar of Vital Statistics .7o,67 rPaul!Franck(Eketronkad 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:
Z Date of Disposition 31111 to Place of Disposition C,Ue�
W (address)
W
N (section) (lot num r (grave number)
G Name of Sexton or Person in Charge of remises f`' L" rf
lease print)
W Signature Title
DOH-1555(o7/18)p 1 of 2
1
1 _
j Public Health Law Sec. 4145(2b) " 13415
Receipt
Human remains of delivered on , 20
A
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#