Collins, Patrick i ilk. -t/Silf
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ,. Burial - Transit Permit
Name First Middle Last Sex
Patrick D Collins Male
Date of Death Age If Veteran of U.S. Armed Forces,
07/0112018 46 years War or Dates 1990-1993
• Place of Death Hospital, Institution or
W City, TIMM AttXMX Saratoga Springs Street Address Saratoga Hospital
1p Manner of Death Natural Cause ❑Accident E„hlomicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
;a Medical Certifier Name Title
41. Michael Sikirica Md
Address
50 Broad St., Waterford, N Y
Death Certificate Filed District Number Register Number
City, TOM-KO(1XiDr X Saratoga Springs 4501 372
❑Burial Date Cemetery or Crematory
❑Entombment 07/03/2018 Pineview Crematory
Address
DCremation Queensbury; N Y
Date Place Removed
Z Removal and/or Held
2❑and/or Address�
Cl)
Hold
O Date Point of
il
❑Transportation Shipment
CZ by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc. 00364
Address
402 Maple Ave.; Saratoga Springs, N Y
Name of Funeral Firm Making Disposition or to Whom
I. Remains are Shipped, If Other than Above
2 Address
Lu
Permission is hereby granted to dispose of the human remains escribed above as indicated.
Date Issued 07/03/2018 Registrar of Vital Statistics 44," i . -4,,„„4
(signature)
gEi District Number 4501 Place Saratoga Springs
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1/4 Id Place of Disposition 01 .
2 (address)
Cl)
IX (section) /jot number) (grave number)
Name of Sexton or Person in Charg of Premises 4 it .3 N'tq
Z
4 (pl se print)
• Signature Title CittinetC;L.
(over)
DOH-1555 (02/2004)