Peacock, Raymond ... ., n- 37 L
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
ini Raymond Everett Peacock Male
Date of Death Age If Veteran of U.S. Armed Forces,
05 / 16 / 2016 88 War or Dates Navy/WWII 1944-1947
i Place of Death Hospital, Institution or
WCity, Town or Village Wilton Street Address 186 Ruggles Road
Q Manner of Death®Natural Cause 0 Accident E Homicide 0 Suicide �Undetermined �Pending
Circumstances Investigation
la Medical Certifier Name Title
Q Leonard M. Gelman MD
Address
20 Prospect St #106, Ballston Spa, NY 12020
IMil Death Certificate Filed District Number>> JyRegiste umber
City, Town or Village Wilton YS-,q.
(Burial Date Cemetery or Crematory
05 / 17 / 2016 Pine View Crematory
I:Iiiiii QEntombment Address
ECremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
fia
0 Date Point of
Q Transportation Shipment
L by Common Destination
00 Carrier
! Q Disinterment Date Cemetery Address
s s
;i:gi Date Cemetery Address
❑Reinterment
Permit Issued to I Registration Number
ib Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
;. 402 Maple Ave., Saratoga Springs, NY 12866
Iii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
to
i
ff:', Permission is h eby granted to dispose of the human remains described abov as indicated.
>i Date Issued Registrar of Vital Statistics / / �7 V.///,/e/17
/ , (signature)
<' District Number /[-l we Place Wilton , New York
Qi
I: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition Place of Disposition 0, ;,,r �rnn r--
- (address)
La 4I41ll4
M (section) 4,0ot numb ) (grave number)
aName of Sexton or Person ip Charge Premises L
z7 , (pease print) .
Signature Title otkotait
(over)
DOH-1555 (02/2004)