Teeple, David . -- ` 1 i
leG
NEW YORK STATE DEPARTMENT OF HEALTH ‘, •
Vital Records Section Burial - Transit Permit
Name First Middle - Last Sex
David F. Teeple Male
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 17 / 2016 31 - War or Dates N/A
}• Place of Death Hospital, Institution or
Z City,Town or Village Malta Street Address 15 Lakeside Ave.
aManner of Death❑Natural Cause 0 Accident ❑Homicide ®Suicide IT❑Undetermined Pending
lii Circumstances Investigation
j Medical Certifier Name Title
Q Daniel J. Kuhn Coroner
Address
Vii
40 McMaster St., Ballston Spa., NY 12020
Miii Death Certificate Filed District Number Register Number
City, Town or Village Malta
12Burial Date Cemetery or Crematory
02 / 19 / 2016 Pine View Crematory
' �0 Entombment Address
F3 Cremation Queensbury, NY
;,;>.,. Date Place Removed
2❑Removal and/or Held
P.— and/or Address
Hold
In
Date Point of
Q Transportation Shipment
42 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
g'i] Liiiiki Permit Issued to Registration Number
1.IName of Funeral Home Compassionate Funeral Care, Inc 00364
. Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Uit
"° Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued„ -1 q.,9Co Registrar of Vital Statistics ciPp; ,,,,, /7f, Wi,
(signatu )
District Number e( 5 0 Place Malta , New York
. I certify that the remains of the decedent identified above were disposed of in ac rdance with this permit on:
2 /1
W Date of Disposition -Z Ill/lb Place of Disposition got, ,.,/ Ln rtoti
1 (address)
fA
CC (section) j(lot umber) (grave number)
aName of Sexton or Person . Charge Premises h/is ��°
2 (pl se punt)
tIii i Title �l�Z�I V 4
Signature
(over)
DOH-1555 (02/2004)