Richute, Michael S. A 3!S
NEW YORKSTATE DEPARTMENTOF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael S.Richute Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/11/2020 75 Years War or Dates 1966-1971
Place of Death Hospital,Institution or
W City,Town or Village Milton Town Street Address 3 Sleepy Court,Milton Town,New York 12020
p Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
WQ Medical Certifier Name Title
Susan Muller MD
Address
510 Geyser Road,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 22
❑Burial Date Cemetery,Crematory or Facility Name
04/14/2020 Pine View Crematory
Entombment Address
Cremation 0ueensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H N Hold Address
0Date Point of
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
°' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/14/2020 Registrar of Vital Statistics Brenda.7fowe(EYectroaicatySoned)
(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:
l~-
Z Date of Disposition ((a Z Place of Disposition
W
m ad ress/
W
N
Ilr (section) (tot nu ber/ (grave number)
aName of Sexton or Person in Ch of Premises
Z (P1 e print
W Signature Title
DOH-1555(07/18)p 1 of 2
1 Public Health Law Sec. 4145(2b) -�-
1
I -
9 Receipt
1
Human remains of delivered on , 20
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Pine View Cemetery Representing the funeral home named burial permit
Official Funeral Directors Reg.or License#44