Colbert, Paul M i35 )
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul M.Colbert Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/27/2020 63 Years War or Dates 1975-1977
Place of Death Hospital,Institution or
W City,Town or Village Milton Town Street Address 449 Route 29 West,Milton Town,New York 12866
p Manner of Death II Natural Cause ❑Accident ❑Homicide ❑Suicide Ei Undetermined ❑Pending
UCircumstances Investigation
0 Medical Certifier Name Title
Carolyn Grosvenor MD
Address
113 Holland Avenue,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 66
❑Burial Date Cemetery,Crematory or Facility Name
12/29/2020 Pine View Crematory
El Entombment Address
lCremation Queensbury Town,New York
ElDonation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
0
id. Date Point of
U) El Transportation
p by Common Shipment
Carrier Destination
ElDisinterment 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
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 12/29/2020 Registrar of Vital Statistics Brenda.7fowe(EYectronrcaQVitae°
(signature)
District Number 4561 Place Ballston Spa, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— _
Z Date of Disposition )2,-3o.w`Z. Place of Disposition P/he v t724 ) C rQ vi lG li
2 (address)
W
CC CC (section) (lot number) (grave number)
0 Name of Sexton or Person i harge of emises vi'i G
Z (please print)
W Signature Title C
DOH-1555(07/t8)p t of 2
Public Health Law Sec. 4145(2b) i 1 4 9
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#