Wilson, Luke I
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NEW YORK STATE DEPARTMENT OF HEALTH Z' /
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Luke Allan Wilson Male
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 19 / 2016 35 War or Dates N/A
i Place of Death Hospital, Institution or
ZCity, Town or Village Providence Street Address 239 Glenwild Road
0 Manner of Death Irj Natural Cause 0 Accident E Homicide 0 Suicide � Undetermined �Pending
14 Circumstances Investigation
ul Medical Certifier Name Title
Q David Shaffer MD
Address
43 New Scotland Ave, Albany, NY 12208
<> Death Certificate Filed District Number Register Number
City,Town or Village Providence
Burial Date 7 / Z 2/ _ 2 x\ 16 Cem y remptory `N4
a ElEntombment !'�� i V qi (�i L ovv�"j-`6-
Address /
MCremation 2_ / (Ati� k � R4 ( l 2eocc---
a
Date Place Removed
❑Removal and/or Held
and/or Address
tta Hold
02, Date Point of
Q fi Transportation Shipment
• by Common Destination
in Carrier
Ri
Disinterment Date Cemetery Address
iil
r Q Reinterment Date Cemetery Address
Permit Issued to ' Registration Number
`: Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
q 402 Maple Ave., Saratoga Springs, NY 12866
:lig Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
W
ILIE
• Permission i he eby granted to dispose of the human re ainsMI
describe above s indicated.
Date Issue Registrar of Vital Statistics l ,Q,
(si re)
Mii
District Number 1---N ,tl Place Providence New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I g Date of Disposition 3J v. /'L Place of Disposition 264 Vi ,.J 1�m ,,..,
(address)
ill
0
IC (section) (lot number) (grave number)
g0 Name of Sexton or Person in Charge of remises (4L, Joliv 4
z /� (p/ se print) .
Signature [/� Title ati AOC
•
(over)
DOH-1555 (02/2004)