Jones, Robert Joseph NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Joseph Jones Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/19/2020 86 Years War or Dates 1953-1956
Place of Death Hospital,Institution or
WCity,Town or Village Ballston Spa Village Street Address Saratoga Center for Rehab and Skilled Nursing
p Mannerof Death Natural Cause Accident Homicide ❑Suicide Undetermined El
Pending
U Circumstances Investigation
Q Medical Certifier Name Title
Mikram Jafri MD
Address
149 Ballston Ave,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa Village 4520 06
❑Burial Date Cemetery,Crematory or Facility Name
03/23/2020 Pine View Crematory
Entombment Address
ICremation Queensbury Town,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
d Date Point of
fq ❑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
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 03/23/2020 Registrar of Vital Statistics ?en,Cee 0Connor(Electronka*Stgne4
(signature)
District Number 4520 Place Ballston Spa Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
WDate of Disposition Place of Disposition `
(address)
W
NIX (section) (lot number) (grave number)
113 Name of Sexton or Person i7Cha a of Premise r-
Z /pleaseprint/
W Signature `—� Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 1 0
Receipt
Human remains of - /T h delivered on '' , 20 1 :
Pine View Cemetery Representing the funeral home named Q burr permit
Y r.;
Official Funeral Directors Reg.or License#�
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