Wells, Raymond it tfUll
NEW YORK STATE DEPARTMENT OF HEALTH ` A
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
mond D.Wells Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/01/2018 89 Years War or Dates 1963-1967
T Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospitalis,
Manner of Death J Natural Cause ❑Accident E Homicide ❑Suicide ❑ Undetermined El Pending
Circumstances Investigation
g Medical Certifier Name Title
Rodney Ying MD
Address
• 211 ChurchSt,Saratoga Springs,New York 12866
i- .: Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 306
❑Burial Date Cemetery or Crematory
kk„ 06/05/2018 Pine View Crematory
Entombment❑ Address
;1®Cremation Queensbury Town, New York
Date Place Removed
0 Removal
40
and/or and/or Held
Address
Hold
g
Date Point of
❑Transportation Shipment
fl
by Common Destination
Carrier
r--1 Date Cemetery Address
411 'Disinterment
n,Q 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
ti Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
K: Address
'Aa Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/04/2018 Registrar of Vital Statistics John P cFranck(ECectronica1Ty Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
4' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ‘j1 Ng Place of Disposition 17,,(4 - tr.,
(address)
I
a- (section) (l number) (grave number)
C
Name of Sexton or Person in Charge of Premises r,T ..w
a j1 (pleas print)
Signature �^r Title l niti'i
(over)
DOH-1555 (02/2004)