Mitchell, Willaim P. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William P.Mitchell Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/20/2020 77 Years War or Dates 1962-1964
Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 246 Old Saratoga Road#6,Moreau Town,New York 12831
p Manner of Death 0 Natural Cause EI Accident El Homicide I=1 Suicide ❑Undetermined 12 Pending
UCircumstances Investigation
LU Medical Certifier Name Title
CI John Pezzulo DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 52
11 Burial Date Cemetery,Crematory or Facility Name
11/24/2020 Pine View Crematory
El Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d. Date Point of
FA El Transportation
p by Common Shipment
Carrier Destination
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
1— Remains are Shipped,If Other than Above
Address
CC
LU
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/24/2020 Registrar of Vital Statistics Leeann.Pcca6e(/ctrortcaf Sfgned)
(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:
W Date of Disposition di Zr 110 Place of Disposition ra
2 (a dress)
W
O(section) (1/ (!ot numbe�-- (grave number)
Name of Sexton or Person in Chemises 11") Vc,✓am^ (it
Z (phase print)
W Signature Title ��Zr'� ITj)V�
DOH-1555(07/18)p t of 2
7 2')9
Public Health Law Sec. 4145(2b)
Receipt
Human remains of,' delivered on , 20
1 'I
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
,� I