Luca, Vincent L �LV
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section 4 Burial - Transit Permit
Name First Middle Last Sex
Vincent T.Luca Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/12/2017 82 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death 0 Natural Cause Accident Homicide El Suicide El Undetermined ri Pending
Circumstances Investigation
is Medical Certifier Name Title
Derek Smith MD
Address
211 Church St,Saratoga Springs, New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 629
.,❑Burial Date Cemetery or Crematory
12/13/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York _
�k Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
', 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
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2017 Registrar of Vital Statistics yoknrPEranck, 'ECectronicalrySigned'
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tc Date of Disposition f Z//z///7 Place of Disposition JP,'h¢ �J:.Lt) Lr�w. y
// (address)
(section) (lotymber) (grave number)
ta Name of Sexton or P .n harge of Premises � c-,./
04-can 0.-4.-4 J-
(please print)
Signature Title c
(over)
DOH-1555 (02/2004)