Villafana, Thomas James 13�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas James Villafana Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/30/2021 41 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W Manner of Death Undetermined 1=1Pending
W El Natural Cause Accident Homicide Suicide El
Circumstances Investigation
WMedical Certifier Name Title
CI Aaron Willen DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 108
❑Burial Date Cemetery,Crematory or Facility Name
02/02/2021 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
NH Hold Address
0
tL Date Point of
(/) ❑Transportation
by Common Shipment
Carrier Destination
❑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
Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/02/2021 Registrar of Vital Statistics join PPaufFranckgkctronicaf SOne0
(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:
Z Date of Disposition 2 S 121 Place of Disposition
2 (address)
W
CC (section) (loypumber) (grave number)
0 Name of Sexton or Person in Charge of remises l/',l` 1'i L�yinn4f 1
Z 1 (please priny
W Signature �/ Title (o trfai—)
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) t .. 1 4 5 n 1
Receipt
Human remains of delivered on , 20 4
I"
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License 4