Newland, Gary NEW YORK STATE DEPARTMENT OF HEALTH '
Vital Records Section Burial Transit Permit
Name First Middle Last Sex
Gary Robert Newland Male
Date of Death Age If Veteran of U.S. Armed Forces,
•
09 / 07 / 201865 War or Dates US Navy
}- Place of Death M, Hospital, Institution or
ZCity, Town or Village Wilton Street Address 125 Pyramid Pines Estates
a Manner of Death®Natural Cause 0 Accident 0 Homicide D Suicide "—Circumstances r—IUndetermined 0 Pending
us. Investigation
Medical Certifier Name Title
C Catherine M. North MD
Address
963 Rte 146, Clifton Park, NY 12065
Death Certificate Filed District Number Registe umber
City,Town or Village Wilton s4
ElBurial Date Cemetery or Crematory
09 / 10 / 2018 Pine View Crematory
ElEntombment Address
Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z❑Removal and/or Held
and/or Address
02
Hold
Date Point of
Q Transportation Shipment
Et", by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
limPermit Issued to Registration Number
Vii Name of Funeral Home Compassionate Funeral Care 00364
iiN
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
< Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t
In
Permission is hereby granted to dispose of the human remains described above as indicated.
git
!;! Date Issued Registrar of Vital Statistics Ø7%f I oe a-ng
(signatufe)
ei
District Number I Place Wilton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ilit Date of Disposition 9 I It 1I1c Place of Disposition PL., s+~10N.,
ME (address)
0
I (section) (lot number (grave number)
al Name of Sexton or Person in Charge of remises - 711
brief,r t 11
z (pl se pnnt)
H.
Signature .c' Title titrAltral .
-
(over)
DOH-1555 (02/2004)