Rhinehart, Kenneth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kenneth P.Rhinehart Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/27/2017 60 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Hudson Street Address Columbia Memorial Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Brian Mccauley MD
4. Address
71 Prospect Ave,Hudson,New York 12534
Death Certificate Filed District Number Register Number
City, Town or Village Hudson 1001 237
0 Burial Date Cemetery or Crematory
12/01/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
: El❑Removal and/or Held
and/or
Address
Hold
k Date Point of
-0701
❑Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
. 0 Name of Funeral Home Compassionate Funeral Care Inc 00364
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
IT
-7. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2017 Registrar of Vital Statistics 7racy Sue(Delaney FCectronicaaySigned
(signature)
: District Number 1001 Place Hudson, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Z Place of Disposition PA11•.../ Actil•'----
(address)
7
_ (section) 4 (lot number) (grave number)
Name of Sexton or Person in C arge of Premi s J(4^v)
�; / ase print)
Signature (�" '� Title °
(over)
DOH-1555 (02/2004)