Greene, David NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
David Greene Male
< ; Date of Death Age If Veteran of U.S. Armed Forces,
10 / 15 / 2015 51 War or Dates N/A
1 , Place of Death Hospital, Institution or
Cityiii , Town or Village Greenfield Street Address 3 Marion Ave
0 Manner of Death l Natural Cause E Accident E Homicide E Suicide 0 Undetermined 0 Pending
Circumstances Investigation
tu Medical Certifier Name Title
ilk
Address
ffii Death Certificate Filed District Number Register Number
City,Town or Village Greenfield 4557 j g
s>`> EiBurial Date Cemetery or Crematory
10 / 22 / 2015 Pine View Crematory
i tjEntombment
Address
EnCremation 21 Quaker Road, Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
tot Hold
itioi Date Point of
Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
iiiiiiii
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Mil Name of Funeral Home Compassionate Funeral Care, Inc 00364
iiN Address
402 Maple Ave. , Saratoga Springs, NY 12866
iiliiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
it
ui
Permission is hereby granted to dispose of the human remains described above as indicated.
ft
111. Date Issued IO/14acil, Registrar of Vital Statistic
(signature)
gii
District Number '7 Place Greenfield , ew York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
Ilif Date of Disposition /c/zz/fs Place of Disposition guiln,,,/ ir r*-
(address)
In
la
Le (section) (lot number) (grave number)
Name of Sexton or Person in C rge of Premises Air f 3101. `1-
+ ► ilzif(please print) •
Signature Title auwiemic
(over)
DOH-1555 (02/2004)