Ross, Earl F. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Earl F.Ross Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/26/2020 64 Years War or Dates 1974-1976
Place of Death Hospital,Institution or
Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide LUndetermined El Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Leonard Gelman MD
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville 5756 67
Burial Date Cemetery,Crematory or Facility Name
10/28/2020 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
6 Removal Date Place Removed
and/or and/or Held
- Hold Address
0
d Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
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
Address
C
W
tL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/28/2020 Registrar of Vital Statistics jenny Linea_farta&( ctronicaf SWnerl?
(signature)
District Number 5756 Place Granville, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition rol ZS I?o Place of Disposition ,L
2 (address)
W
CC
CC (section) aloftaumber/ S----ovt4440 (grave number)
(plea4e
Name of Sexton or Person in Char of Premises /(�!w print)
�-' L
W Signature L Title (13444
11�Y
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01415
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on laurial permit
Official Funeral Directors Reg.or License#