Mayer, Reinhard NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
MI Name First Middle LastSex
Reinhard Albert ayer Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/24/2013 71 years War or Dates
Place of Death Hospital, Institution or
Z CNPMwn or ViliNAXX Greenfield Street Address 81 Locust Grove Road
Iii
Manner of Death❑Ddatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
MI Circumstances Investigation
;u Medical Certifier Name Title
4.41 John Delmonte Jr. M D.
Addr3ssare Lane Suite 300, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
IN Ci , Awn or ViIX Greenfield 4557 21
Ni❑Burial Date Cemetery or Crematory
12/27/2013 Pine View Crematorium
M El Entombment Address
❑cremation Queensbury, New York
Date Place Removed
Removal and/or Held
2 [—I and/or Address
U)
Hold
0 Date Point of
th Li Transportation Shipment
0 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
iiiii ❑Reinterment Date Cemetery Address
s> Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc. 00364
! Address
402 Maple Avenue, Saratoga Springs, N Y12866
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
2 Address
IX
Lu
94 Permission is hereby granted to dispose of the human remains described above as indicated.
iii Date Issued 12/26/2013 Registrar of Vital Statistics" 't-�
(signature)
District Number 4557 Place Greenfield
il I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�J it
to Date of Disposition iaa-�F-i3 Place of Disposition 1'1ntVbW nn1 C —
2 (address)
AU
W.
IX (section) (I number) (grave number)
ci Name of Sexton or Person in Charge of Premises ''
z (pleasA print)
iiiiii Signature4,A-: Title Oii; mt-TO&
(over)
DOH-1555 (02/2004)