Symonds, Christopher J. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christopher J.Symonds Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/02/2020 44 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Mannerof Death
Natural Cause Accident Homicide Suicide Undetermined Pending
UCircumstances Investigation
Q Medical Certifier Name Title
David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 268
Burial Date Cemetery,Crematory or Facility Name
05/09/2020 Pine View Crematory
Entombment Address
ICremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
l-
N Hold Address
O
C- Date Point of
N 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 —700364
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
Cr
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/06/2020 Registrar of Vital Statistics ,7o,67 Paul Franck(ElectronicallyS#ned)
(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 e-'Z0 se
20 Place of Disposition l i-I-)e U iC' era-,
2 (address)
W
N
I M (section) /(lot number) (grave number)
aName of Sexton or Person in e f Premises LAI Gc✓N
Z (please print)
W Signature Title ''►"
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 1 .'3 7 5 4
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home name'on burial permit
Official Funeral Directors Reg.or License#-,d