Jenkins, Paul NEW YORK STATE DEPARTMENT OF HEALTH 03
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paul A. Jenkins Male
1 Date of Death Age If Veteran of U.S. Armed Forces,
06 / 02 / 2017 69 War or Dates N/A
.4 Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address
Saratoga Hospital
a Manner of Death®Natural Cause E Accident Homicide E Suicide Undetermined �Pending
tilCircumstances Investigation
jtu Medical Certifier Name Title
0 Timothy A. Brooks MD
Address
211 Church Street Saratoga Springs, NY 12866
>> Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 5D1 2 C Q
>s 0Burial Date Cemetery or Crematory
06 / 05 / 2017 Pine View Crematory
:!'] 0Entombment Address
3 ECremation Queensbury, NY
;<: Date Place Removed
❑Removal and/or Held
• and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
iig
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
:,
gi Permit Issued to Registration Number
ifiiii Name of Funeral Home Compassionate Funeral Care 00364
Address
'fj 402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
.
AW
Permission is hereby granted to dispose of the human rem s de cr' d ad1 indicat .
<`'. Date Issued (i\5\ Registrar of Vital Statistics ii
(signature)
gii District Number yJvI Place Saratoga Springs , New York
"' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t
Ili Date of Disposition ‘'gin Place of Disposition firici[A-/ gm IA-
2 (address)
iii
lE (section) lot number (grave number)
gName of Sexton or Person ip Charge of P, emises C/'1r` r JIMA lit
at J� (ple se punt) •
41.
Signature c�,/MCIG Title CRENI
'7 (over)
DOH-1555 (02/2004)