Brownell, Peter T / ,NEW YORK STATE DEPARTMENT OF HEALTH # I/
O'I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Peter A Brownell Male
Date of Death Age If Veteran of U.S. Armed Forces,
08 / 27 / 2016 56 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address 295 Jefferson St.
0 Manner of Death®Natural Cause E Accident E Homicide Suicide Undetermined Pending
6-1 Circumstances Investigation
tu Medical Certifier Name Title
O Theodoros Laddis MD
Address
6 Care Ln, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs
iii:iili Date Cemetery or Crematory
08 / 29 / 2016 Pine View Crematory
DEntombment ,Address
ECremation 21 Quaker Road, Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
g Hold
q i, Date Point of
Q Transportation Shipment
by Common Destination
iiiql Carrier
Q Disinterment Date Cemetery Address
lii
Reinterment Date Cemetery Address
>iiii: Permit Issued to Registration Number
-<> Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp., NY 12866
Di Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
ie
t'a
'" Permission is hereby granted to dispose of the human rema' scr' ed aye a indicated.
Date Issued n 12 9 I2D I Registrar of Vital Statistics Y
(signature)
Oii District Number L s 1 Place Saratoga Springs , New York
»:. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
P Dispositionkk Cam^
I� Date of Disposition $�30116 Place of r
(address)
fli
= (section) ltui0Lr
(lot number) c (grave number)
CIName of Sexton or Person in Chargeof Premises Se4 J42D (please print) •
• Signature 2L Li Title C1��4—
(over)
DOH-1555 (02/2004)