Schiltz, Stephen NEW YORK STATE DEPARTMENT OF HEALTH '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Stephen Sylvester Schiltz Male
Date of Death Age If Veteran of U.S. Armed Forces,
05 / 04 / 2017 61 War or Dates 1977-1981
Place of Death Hospital, Institution or
Citytij , Town or Village Queensbury Street Address 12E Finch Way _
a Manner of Death®Natural Cause 0 Accident E Homicide E Suicide El Undetermined 0 Pending
W. Circumstances Investigation
tu Medical Certifier Name Title
a. Douglas J. Dennett MD
Address
84 Broad St. Glens Falls, NY 12801
ni Death Certificate Filed pistrict Number Register Number
City, Town or Village Queensbury C)
> Burial ii pi Date Cemetery or Crematory
::::<, 05 / 08 / 2017
;g Entombment Pine View Crematory
Address
i` uCremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
0
Hold
0 Date Point of
41 0 Transportation Shipment
is by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Ej Reinterment Date Cemetery Address
Permit Issued to Registration Number
iiii Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
lig Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ar Address
CC
In
Permission is hereby granted to dispose of the huma re sins described above as indicated.
<, Date Issued)V) j-) Registrar of Vital Statistics Q
(signature)
«? District Numbe'&0 c ) Place Queensbury
,, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 �s
ILI Date of Disposition ci110 Place of Disposition line\Lw l: ,dt•r.,..
(address)
iii
tti
it (section) //(lot number) (grave number)
aName of Sexton or Person in Charge f Premises '. ,/ i st . _0 mete
2 (ple se print) •
Signature �'� 4) Title 1�'€.t11"r�i� . _
(over)
DOH-1555 (02/2004)