Palmateer, Charles �1 ego
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Charles M Palmateer Male
Date of Death Age If Veteran of U.S. Armed Forces,
05 / 11 / 2015 53 War or Dates
} Place of Death Hospital, Institution or 980 Murray Rd Lot 14
W ) iV, Town Greenfield Ctr. Street Address
p Manner of Death Natural Cause ❑Accident E1Homicide 1=1Suicide ❑Undetermined 7 Pending
Uj Circumstances Investigation
W Medical Certifier Name Title
Q Michael Sikirica MD
Address
50 Broad St, Waterford, NY 12188
al Death Certificated District Number
5� Registermber
, Town or Greenfield Ctr.
Burial Date Cemetery or Crematory Pine View Crematory
05 / 14 / 2015
Mii(Entombment Address
OCremation 21 Quaker Road, r :ensbury, NY
Date Place Remo'
4❑Removal and/or He'
and/or Address
Hold
yt
C Date Point
Q Transportation Ship it
Gs by Common Destination
Carrier
MQ Disinterment Date Ce 3tery Address
:>:,Q Reinterment Date Cemetery Address
d
Permit Issued to j Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
:.. Remains are Shipped, If Other than Above
2 Address
tr
U
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 5/j Lt J of S Registrar of Vital Statistic � _. r
(signature)
' District Number t133`7 Place Greenfield Ctr. , New York
<::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ili Date of Disposition S j t,fic Place of Disposition 4,14..., f'r.40c
--
Z. (address)
ta
CC (section) ff (lot number) (grave number)
Name of Sexton or Person in Charge of Premises `'�'
Z (p1 ase print) •
tE Signature �N Title ►'11 t
(over)
DOH-1555 (02/2004)