Minnick, Cale ! s
NEW YORK STATE DEPARTMENT OF HEALTH H/
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Cale Minnick Male
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 21 / 2016 29 War or Dates N/A
IF Place of Death Hospital, Institution or
ZCity, Town or Village Wilton Street Address
a Manner of Death ID Natural Cause 0 Accident 0 Homicide ElSuicide ❑Undetermined ®Pending
.111
Circumstances Investigation
til Medical Certifier Name Title
0 John Keegan Coroner
Address
112 State Street, Albany, NY
Death Certificate Filed District Number � Register Number J
City, Town or Village Wilton 1-0� 1/4.?
il].!;..ii.i['Burial Date Cemetery or Crematory
09 / 26 / 2016 Pine View Crematory
i ElEntombment Address
( ! ECremation Queensbury, NY
Date Place Removed
g❑Removal and/or Held
E and/or Address
CI
Hold
0 Date Point of
i Transportation Shipment
Pi;
a by Common Destination
Carrier
Disinterment Date Cemetery Address
''" Reinterment Date Cemetery Address
Permit Issued to Registration Number
iiiiii
Name of Funeral Home Compassionate Funeral Care 1 00364
: Address
402 Maple Ave., Saratoga Sp., NY 12866
Ziiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
14
"i Permission is hereby granted to dispose of the human remains described abov as indicated.
<l Date Issued C j Registrar of Vital Statistics �1
(signature),"
>_ District Number ys- Place Wilton , New York
' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
III Date of Disposition 61174/IL Place of Disposition eiintC..,r C ►af ors.•
E (address)
tia
CO
CC (section) if (lot number) (grave number)
IIName of Sexton or Person ip Charge of Premises ` r P strA:�'
z ( lease print) .
i Signature Title
(over)
DOH-1555 (02/2004)