Talbot, Edward NEW YORK STATE DEPARTMENT OF HEALTH 3 53
Vital Records Section Burial - ransit Permit
Name First Middle Last Sex
Edward Talbot Male
Date of Death Age If Veteran of U.S. Armed Forces,
04 / 28 / 2016 63 War or Dates
1 , Place of Death Hospital, Institution or
Z City, Town or Village Malta Street Address 685 State Rte 67
0 Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide ❑ Undetermined 0 Pending
laiCircumstances Investigation
Ili Medical Certifier Name Title
44 Suzanne Palmieri DO
Address
990 State Route 67 Ste 101, Ballston Spa, NY 12020
Death Certificate Filed District Number Register Number
;< City, Town or Village Malta
` Burial Date / / Cemetery or Crematory
Entombment Pine View Crematory
Address
iim cm
Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address
MA
') Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
aiiiii Permit Issued to ' Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
M Address
402 Maple Ave., Saratoga Springs, NY 12866
gig Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
ILI
CL
Permission is hereby granted to dispose of the human remains described ove as in 'sated.
Date Issued LA faotb Registrar of Vital Statistics
(signature)
iWi
District Number ys(20 Place Malta , New York
A 14 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lit Date of Disposition 61Z lit, Place of Disposition fr ,L,
SE (address)
lii
M (section) (lot/ tuber) S'eAA1 (grave number)
IIName of Sexton or Person ip Charge ofpremises �h�
2t (please p t) . /►
Signature Title �� "J
(over)
DOH-1555 (02/2004)