Leininger, Scott ZAP
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Scott W.Leininger Male
y ,.y
Date of Death Age If Veteran of U.S. Armed Forces,
03/19/2018 59 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
;���•��j� Manner of Death a Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 169
❑Burial Date Cemetery or Crematory
03/20/2018 Pine View Crematory
El Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal
and/or Held
and/or Address
Hold
L3� Date Point of
1❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
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
w,-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/20/2018 Registrar of Vital Statistics John cP Eranck(Etectronically Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3)11113 Place of Disposition
(address)
(section) 4(Iot numbel- (grave number)
Name of Sexton or Person in Charge of Premises L 114
(pi ase print)
i 1 Signature Title *OW,
riW,
(over)
DOH-1555 (02/2004)