Yandoh, Keith Thomas NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Keith Thomas Yandoh Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/23/2020 84 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Church St,Saratoga Springs,New York 12866
p Mannerof Death 1 Natural Cause Accident Homicide Suicide Undetermined Pending
V El
Circumstances Investigation
QW Medical Certifier Name Title
Patricia Ford MD
Address
445 New Karner Road,Colonie Town,New York 12205
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 189
Burial Date Cemetery,Crematory or Facility Name
03/26/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
d Date Point of
N Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment T
ate 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 Otherthan Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/26/2020 Registrar of Vital Statistics joltn<Paul�rancE��Yectronica�Stgne�
(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
lL Date of Disposition -2$-2U2Q Place of Disposition �y►C� V j C u1 L r Pmw a r
2 (address)
W
N (section) (lot number) (grave number)
aName of Sexton or Person in rg r miser "w 1 G
Z (please print) /
W Signature Title Gre"75�
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 13 47 7
Receipt
f
Human remains of delivered on / ; 20
f i
Pine view Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# r- r