Gates, Alberta A. 11
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Alberta A.Gates Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/26/2020 74 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Milton Town Street Address Gateway
WW Manner of Death
Natural Cause Accident Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
Q Medical Certifier Name Title
Stephen Kineke MD
Address
1783 Route 9 203,Clifton Park Town,New York 12065
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 20
❑Burial Date Cemetery,Crematory or Facility Name
03/30/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
(L Date Point of
CO) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Nun.per
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
it
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/30/2020 Registrar of Vital Statistics BreadaJAY'~(EkctronicatT Sonedl�
(signature)
District Number 4561 Place Ballston Spa, 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 111110 Place of Disposition r�
2 (address/
W
NIM (section) (lot number) (grave number)
13 Name of Sexton or Person in Charge o3P ' t`es L, ,-
Z (p ase print) �^
W Signature Title ! "
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013492
Receipt
Human remains of c. delivered on , 20
Pine View Cemetery Representing the funeral home named on purial permit
Official Funeral Directors Reg.or License#