Helm, Peter ,. , # siy1
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
:; Name First Middle Last Sex in
Peter F. Helm
Date of Death Age If Veteran of U.S.Armed Forces,
11 / 25 / 2016 63 War or Dates
,,' Place of Death Hospital, Institution or
City,Town or Village South Glens Falls Street Address 210 Main Street
1 Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name z Title ,
ra riCICL. l'atfe >Z 11%f
Address
Agt
Death Certificate Filed 7 District N�umbdr ister Number
`
' City, Town or Village South Glens Falls i(2.ti
OBurial Date Cemetery or Crematory
11 / 28 / 2016 Pine View Crematory
:? ®Entombment Address
€' );Cremation Queensbury, NY
Date Place Removed
tr--y❑Removal and/or Held
and/or}, Address
Hold
Date Point of
['Transportation _ Shipment
ffi by Common Destination
• Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
i. Name of Funeral Home Compassionate Funeral Care 00364
<<_: Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
;;•A Remains are Shipped, If Other than Above
Address
rry
rm
Permission is hereby granted to dispose of the human rem ins described above asl indicated.
Date Issued 0,5,-fruep Registrar of Vital Statistics , /�jJ7)2' ,6c Ci��
11 i24f' en /` (s,;�hna�ture).rc
District Numbed f � �'� Place
South Glens Falls , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /I At,jjI, Place of Disposition es ncUtcs.i C tmert-ar,v..,
- (address)
(section) jj(�lot number) r (grave number)
Name of Sexton or Person ip Charge of Premises ( All tr .3 t++/rf
/I (p a print).
Signature t 1:77 Title ett inti- (over)
DOH-1555 (02/2004)