Zimmer, Peter NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
1
▪ Name First - Middle Last Sex
PETER JAMES ZIMMER MALE
▪ Date of Death Age If Veteran of U.S.Armed Forces,
r 1• 1/13/2017 61 War or Dates
Place of Death Hospital, Institution
Cit ,Town or Villa e Cit of Alban or Street Address ST. PETERS HOSPITAL
Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Cause _ Circumstances Investigation
I'll` Medical Certifier Name Title
4:1VINCENT WONG MD
44 Address
2 PALISADES DR., ALBANY NY 12205
Death Certificate Filed District Number Register Number
: City,Town or Village City of Albany 1011470
Date Cemetery or Crematory
❑ Burial 11/14/2017 PINE VIEW CREMATORY
❑ Entombment Address
F4 Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
0' ❑ and/or Address
1- Hold
CO
Date Point of
0 Transportation Shipment
N ❑ By Common Destination
Carrier
❑ Disinterment Date Cemetery Address
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home COMPASSIONATE FUNERAL CARE, INC. 00364
A• ddress
402 MAPLE AVE., SARATOGA SPRINGS NY 12866
= Name of Funeral Firm Making Disposition or to Whom
`; Remains are Shipped, if Other than Above
A• ddress
Lu
Permission is hereby granted to dispose of the human remains describ/'t.t't't '1
das in
Date 11/13/2017 Registrar of Vital Statistics -
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
b' Date of Disposition
p 11 114 111 Place of Disposition p> a�.J e tw`
. (address)
Ili
y'
Q (section) (lot number) (grave number)
t]
Name of Sexton or Person in Charge of PremisesIli
AIL 3 rn�4
(please print)
Signature A Title tOF Ma
(over)
DOH-1555 (02/2004)