Spencer, David Leo NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
David Leo Spencer Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/09/2020 78 Years War or Dates
t— Place of Death Hospital,Institution or
Z City,Town or Village Malta Town Street Address 26 Rockrose Way,Malta Town,New York 12020
LU
pManner of Death ❑X Natural Cause ❑Accident ❑Homicide I=1 Suicide ❑Undetermined ❑Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Daniel Eldredge DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Malta 4560 57
❑Burial Date Cemetery,Crematory or Facility Name
12/10/2020 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
N 1-1
Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
El 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
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/10/2020 Registrar of Vital Statistics .7ennkir Mark.7foarte (Ekctronrca*,S0e42
(signature)
District Number 4560 Place Malta, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H (
Z Date of Disposition 1Z//)1 Z Place of Disposition
2 (address)
LU
CC (section) n(!ot number) (grave number)
gName of Sexton or Person in Charge of r mises [/"(� ��tf
Z (please rint)
W Signature Title li'►�rt(
DOH-1555(07/18)p id 2
Public Health Law Sec. 4145(2b) 014391
Receipt
Human remains of _delivered on , 20..
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#