Reinhardt, John NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Reinhardt Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/17/2020 58 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 408 Fortsville Road,Moreau Town,New York 12831
`p Manner of Death M. Natural Cause ❑Accident ElHomicide ElSuicide ❑Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Edward Liebers MD
Address
3 Care Lane,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 51
❑Burial Date Cemetery,Crematory or Facility Name
11/23/2020 Pine View Crematory
ElEntombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
(A Hold Address
0
a. Date Point of
Cl) ❑Transportation
In Common Shipment
Carrier Destination
E
Disinterment
Dale 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
1— Remains are Shipped,If Other than Above
5 Address
CC
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/23/2020 _ Registrar of Vital Statistics Leeann ca6eglectronrcaliMpea)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
FriA.
Z Date of Disposition �Ji7SiZQ Place of Disposition
2 (address)
W
CC (section) ( �"number) (grave number)
0 L 4«A/ft
Name of Sexton or Person in Chary f Premises
(please Tint)
Z
• Signature Title
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) - ).1..%4 2" I
Receipt
Human remains of ;��� ' delivered on , ` , , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#