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Schmid, Donald NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Schmid Male Date of Death Age If Veteran of U.S.Armed Forces, 05/16/2020 75 Years Waror Dates Korea Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title Carlos Ares MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 284 ❑Burial Date Cemetery,Crematory or Facility Name ❑Entombment 05/19/2020 Pine View Crematory Address FRI Cremation Queensbury Town,New York ❑ Donation OZ ❑Removal Date Place Removed and/or and/or Held N Hold Address O d Date Point of N ❑Transportation by Common Shipment Carrier Destination ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address c W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/18/2020 Registrar of Vital Statistics John Tau(Tranck(ECectronicaCCy Signer (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: W Date of Disposition y (q'z� Place of Disposition JA�2Gy 2`�. �leesc� 2 (address) W U) M (section) Q (lot number) (grave number) aName of Sexton o s in Cha e of Premises l�h f'7`S�/3 f- C�e/tkuzr Z (please print) W Signature Title etE"x rU k DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#