Grimes, Joseph M Gv1_
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph Grimes Male
Date of Death Age If Veteran of U.S. Armed Forces,
0B / 13 / 2018 79 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Easton Street Address 36 Hegeman Bridge Rd
a Manner of Death®Natural Cause D Accident Homicide E Suicide 0 Undetermined �Pending
Circumstances Investigation
O.
tgi Medical Certifier Name Title
0 David M. Mastrianni MD
Address
3 Care Ln #300, Saratoga Springs, NY 12866
s`:= Death Certificate Filed District Number Register Number
City,Town or Village Easton
> Burial Date - Cemetery or Crematory
08 / 15 / 2018 Pine View Crematory
,RAJEntombment
Address
iiiN ECremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
h Hold
O.
0 Date Point of
Q Transportation Shipment
by Common Destination
Carrier
'`: Q Disinterment Date Cemetery Address
s Q Reinterment Date Cemetery Address
i€< Permit Issued to Registration Number
z Name of Funeral Home Compassionate Funeral Care 00364
Address
iii] 402 Maple Ave., Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
i
Permission is he eby anted to dispose of the human remains described above as indicated.
Date Issued ��1k Registrar of Vital Statistics at a gyp,,,,, ®,s e, ,Z-
HP (signature)
District NumberLi-753 Place Easton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ilo
11,1 Date of Disposition slog Place of Disposition ,��„u,,,
l t?�,
(address)
Iti
CC (section) (lot n beryl ( (grave number)
IIName of Sexton or Person in Charge of Premises &ip` ...)...40
z pp (please p t) .
Signature irr� Title
(over)
DOH-1555 (02/2004)