Cole, Cynthia it PR
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Cynthia Cole Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/10/2020 65 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Wilton Town Street Address 11 Knollwood Drive,Wilton Town,New York 12866
• Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI John Delmonte MD
Address
3 Care Lane,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 44
❑Burial Date Cemetery,Crematory or Facility Name
10/13/2020 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped,If Other than Above
Address
CC
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/13/2020 Registrar of Vital Statistics Susan Ballwin(Electrontiall:y Srgnerl)
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this p i n:
H
W Date of Disposition /M61 Zp Place of Disposition
2 (address)
W
CC (section) J (lot number) � (grave number)
a Name of Sexton or Person' harge of Premises G L
(p ase print)
Z
• Signature Title C 12 eeti119-
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01`''r
�1 0
Receipt
Human remains of ` delivered on " , 20 `'
Pine View Cemetery Representing the funeral home named b?burial permit
Official Funeral Directors Reg.or License# 4' �.