Brown, Andrew NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Andrew Brown Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/20/2021 96 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address 1 S Federal Street Apt 707,Saratoga Springs,New York 12866
p Manner of Death J Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined El Pending
111
0 Circumstances Investigation
WCt Medical Certifier Name Title
Tracey Brennan MD
Address
324 West Avenue,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 61
❑Burial Date Cemetery,Crematory or Facility Name
01/21/2021 Pine View Crematory
Entombment Address
iCremation Queensbury Town,New York
EIDonation �.
iRemoval Date Place Removed
and/or and/or Held
NHold Address
0
d 1-1 Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
EIDisinterment Date Cemetery Address
ElReinterment 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
F.- 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 01/21/2021 Registrar of Vital Statistics loin 2'aulFranck�rElectronicalTy Stgne�
(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:
W Date of Disposition /2_j-2eZ/ Place of Disposition � �e 0:�) Creyn4-f G(
2 (address)
W
CC (section) // (lot mberl (grave number)
0 Name of Sexton or Person in Char e of Premises /'S A7 I110nJ D
Z / (please print)
W Signature � -1/2 Y `�e.
g Title Q��<�, J'^
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) G 1 w 4 4 8
Receipt
Human remains of . a delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#