Cea, Frank NEW YORK STATE DEPARTMENT OF HEALTH I z
Vital Records Section Burial - Transit Permit
<; Name First Middle Last Sex
Frank - Cea Male
Date of Death Age If Veteran of U.S. Armed Forces,
06 / 04 / 2016 85 War or Dates
1- Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Wesley Health Care Center
aa ®Manner of Death Natural Cause 0 Accident 0 Homicide Suicide � Undetermined �Pending
l Circumstances Investigation
ill Medical Certifier Name Title
0 Matthew C. Pender MD
Address
131 Lawrence St. Saratoga Springs, NY 12866
Death Certificate Filed District Number I Register Number
City, Town or Village Saratoga Springs
Mii Burial Date f / // ` Cemetery or CrematoryEntombment Ut (� ( Pine View Crematory
Address
Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
A Date Point of
Q Transportation Shipment
cf by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
iiiii Permit Issued to ! Registration Number
Mii Name of Funeral Home Compassionate Funeral Care, Inc 1 00364
Aii Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
at
3LI
Permission is hereby granted to dispose of the human rema' or' ed atre indicate .
Date Issued t!1 (.9 QQ 1� Registrar of Vital Statistics
l
(signature)
District Number 45u Place Saratoga Springs , New York
#+ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
III Date of Disposition 4/13(I6 Place of Disposition 4?, (Jrs.#.- a,Nr+►Atirt.
(address)
Ill
CC (section) (lot number) (grave number)
0 Name of Sexton or Person ip Char a of Premises '. i r St
z /� ( ease print) •
114 Signature L� Title1�+�
(over)
DOH-1555 (02/2004)