Schultz, Craig James 131z2
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Craig James Schultz Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/13/2020 69 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Providence Town Street Address 237 Glenwild Road,Providence Town,New York 12850
p Manner of Death a Natural Cause 0 Accident 1=1 Homicide Ei Suicide ❑Undetermined Pending
o Circumstances Investigation
0 Medical Certifier Name Title
Anthony Perniciaro Coroner
Address
6012 County Farm Road,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Middle Grove 4564 6
ElBurial Date Cemetery,Crematory or Facility Name
12/21/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
C Date Point of
U) Li Transportation
El 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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/19/2020 Registrar of Vital Statistics Swan Z1/emple(f/ectronica(Signed)
(signature)
District Number 4564 Place Middle Grove, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l—
W Date of Disposition 11.-2z Z020 Place of Disposition `') "�- i, t'J/tni
2 (address)
W
Cl) (section) ` t number) / (grave number)
aName of Sexton or Person i harge of Premises �1 in /r G ✓I a-cA
(please print)
W Signature Title Ciemo o7 42/e
DOH-1555(07/18)p i of 2 1/
Public Health Law Sec. 4145(2b) 01 4 3 2
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#