Cole, William ' 3
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
William F. Cole Male
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 10 / 2016 75 War or Dates
} Place of Death Hospital, Institution or
WCity, Town or Village Northumberland Street Address 6 Gates Ave. North
etManner of Death®Natural Cause ❑Accident �Homicide �Suicide Undetermined Pending
Circumstances Investigation
uj Medical Certifier Name Title
Q Nancy Barraclough NP
Address
IN 3050 Route 50, Saratoga Springs, NY 12866
<` Death Certificate Filed District Number u Register Number
>'`: City,Town or Village Northumberland 6 go
=C2Burial Date Cemetery or Crematory
:a 01 / 11 / 2016 Pine View Crematory
;i ;®Entombment Address
`i OCremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
{? and/or Address
CA
Hold
0 Date Point of
SQ Transportation Shipment
by Common Destination
N. Carrier
❑Disinterment Date Cemetery Address
iii
'l 0 Renterment Date Cemetery Address
iiiigi Permit Issued to Registration Number
€<` Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
:m Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
f •
Permission is hereby granted to dispose of the human remains described above as indicated.
illi Date Issued a1\\Q\Qot� Registrar of Vital Statistics
(signature ,
C,
:, District Number L5 Place Northumberland , New York
Oii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lit P 1 Xli+cUlL Crrim'CiOri� -
Date of Disposition ! /�{� (, Place of Disposition � � .-�
2 (address)
tii
tO
lC (section) (lot number) (grave number)
el Name of Sexton or Person ip Charge of P emises ii. tnNt'l'-
,Z /� ( ease print) •
SiiSignature L�- I Title moll OL
(over)
DOH-1555 (02/2004)