Krywy, Donald H. il 3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donald H.Krywy
Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/21/2020 71 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Ballston Spa Village Street Address 52 Division Street,Ballston Spa Village, New York 12020
111
Ci Manner of Death ❑X Natural Cause El Accident ID Homicide ❑Suicide 0 Undetermined 0 Pending
W U Circumstances Investigation
W Medical Certifier Name Title
CI Stephen Strader MD
Address
61 Rowland Street,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa Village 4520 37
❑Burial Date Cemetery,Crematory or Facility Name
10/23/2020 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Date Place Removed
Removal and/or Held
H- and/or
N
- Hold Address
0
Date Point of
N ❑Transportation Shipment
Q by Common
Carrier Destination
0 Disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
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
1-- Remains are Shipped,If Other than Above
g Address
CC
LU
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/23/2020 Registrar of Vital Statistics Ten Lee OConnor(Ekctronttaf Signer!)
(signature)
District Number 4520 Place Ballston Spa Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH '/
Z Date of Disposition 10 Izq 11O Place of Disposition 1
W (ad ress)
LU
N (section) (lot number) (grave number)
CC
0 Name of Sexton or Person in Charge Premises ,r to se.,
P.gild
(P P
rin
Z /1h,.." �
W Signature 'C� Title L�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) �� 4 .
Receipt
Human remains of delivered on , 20
i
E.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#