Vanne,Vesa NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Vesa Vanne Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/01/2021 63 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Wilton Town Street Address 23 Northern Pines Road 1304,Wilton Town,New York 12831
W
p Manner of Death IJ Natural Cause Ei Accident Homicide Ei Suicide ❑Undetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
John Mongan DO
Address
3 Care Lane,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 11
❑Burial Date Cemetery,Crematory or Facility Name
03/02/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
Donation
61 Removal Date Place Removed
and/or and/or Held
NF- Hold Address
0
d 1-1 Date Point of
U) ❑Transportation
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
LU
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/02/2021 Registrar of Vital Statistics Susan Ballwin(EYectronica/T Sr fined)
(signature)
District Number 4569 Place Gansevoort, 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 315121 Place of Disposition
2 (address)
Ui
0 (section) ,(!ot number) (grave number)
` N tpL
Name of Sexton or Person in Charge of Pre .ses f� `^ ^�
(please rint)
W Title tiVIA
Signature f
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
{
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#