Myrie, Cecil f , A G1
NEW YORK STATE DEPARTMENT OF HEALTH -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Cecil Myrie Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/07/2014 86 years War or Dates
Place of Death Hospital, Institution or
W City, MWRYPICVAINRX Saratoga ES rings Street Address Sarato a Hoc ital
p Manner of Death ,Natural Cause 11111 Accident ❑Homicide ❑Suicide 0 Undetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
C) Carlos A Arpc Md
Address
211 Church Street, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, ToXIXXAVANIXX Saratoga Springs 4501 AS,
El Burial Date Cemetery or Crematory
['Entombment Pine View Crematory
Address
[]Cremation Queensbury. N Y
Date Place Removed
Z ❑Removal and/or Held
and/or Address
H Hold
Ell
0 Date Point of
L/k111 Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
s Address
ilk
ill
Permission is hereby granted to dispose of the human remai s des gtbor dicate
Date Issued 10/09/2014 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above we disposed of in a ordance with this permit on:
ili Date of Disposition —///Place of Disposition /�h�,�.rJ %C
2 r MID Y
(address)
U
til
l r (section) ber (grave number)
G Name of Sexton o e ,, ' harge of Premises fI7um
r7
I ci
/ 644):::7;t_pri
1,0 Signature Title
(over)
DOH-1555 (02/2004)