Pettigrew, Richard 1 it 70)
NEW YORK STATE DEPARTMENT OF HEAH •
Burial Records Section Burial - Transit Permit
,: Name First Middle Last Sex
Richard James Pettigrew Male
Date of Death Age If Veteran of U.S. Armed Forces,
08/24/2018 63 Years ,,War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs , Street Address Saratoga Hospital
Manner of Death 0 Natural Cause Ei Accident 0 Homicide 0 Suicide El Undetermined ri Pending
Circumstances Investigation
to Medical Certifier Name Title
0 Jacqueline Smith DO
Address
,,..L 211 Church St,Saratoga Springs,New York 12866
a. Death Certificate Filed District Number Register Number
City, Town Or Village Saratoga Springs 4501 477
❑Burial Date Cemetery or Crematory
ai 08/28/2018 Pine View Crematory
r!g❑Entombment Address
1'®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address
• Hold
Date Point of
Transportation Shipment
• by Common Destination
Carrier
Q Disinterment
Date Cemetery Address
.0
Q Reinterment Date Cemetery Address
IA Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
ti 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
Permission is hereby granted to dispose of the human remains described above as indicated.
q Date Issued 08/27/2018 Registrar of Vital Statistics John T Eranck(E(ectronical(ySigned)
(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:
27 Date of Disposition )113) I I8 Place of Disposition 6..,0„r Grano-".
(address)
II
' (section) (lot numpr) C (grave number)
Name of Sexton or Person in Charge of Premises l ici'i--k J s ii
t" Q,
(please print)
.- Signature �^^ Title ( (1)4 jUn
-
(over)
DOH-1555 (02/2004)