Richmond, John E. , . it 171
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John E.Richmond Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/05/2020 81 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
11.1
p Manner of Death 0Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ElPending
V Circumstances Investigation
W Medical Certifier Name Title
Rodney Ying MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 628
❑Burial Date Cemetery,Crematory or Facility Name
12/07/2020 Pine View Crematory
ElEntombment Address
X❑Cremation Queensbury Town,New York
▪Donation
iRemoval Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
co ❑Transportation
p by Common Shipment
Carrier Destination
El
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
E . Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2020 Registrar of Vital Statistics join Paul ranck( CtranicaK SWfled)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l- eta--
Z Date of Disposition aI$I to Place of Disposition :— ,
2 (address)
W
CC U)
(section) hoot number) (grave number)
O▪ Name of Sexton or Person in Char g ,f Premises �/,r Lc ^�l�
Z (pleasprint)
lL Signature /�� Title C►��w��v�
s
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) J 1_4 2 71
Receipt 1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#