Martin, Charles NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Charles Martin Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/27/2021 69 Years War or Dates 1969-1971
F_ Place of Death Hospital,Institution or
Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
p Manner of Death ❑X Natural Cause Accident El Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Leonard Gelman MD
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville 5756 10
❑Burial Date Cemetery,Crematory or Facility Name
01/29/2021 Pine View Crematory
Entombment Address
lCremation Queensbury Town,New York
El Donation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
0
CL 1-1 Date Point of
Cl) ❑Transportation
CI 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
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 01/29/2021 Registrar of Vital Statistics JennyGinda Marta'(Ekctronicaf Signed)
(signature)
District Number 5756 Place Granville, 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 MO_,oaf Place of Disposition ?; eet) ,/-rijsQQ
2 (address) -�
W
CC (section) / (lot number) (grave number)
o l iliV1-11 u
c✓
0 Name of Sexton or Person in Char of Premis
(please print)
W Signature �v` Title 0� el— 1
DOH-1555(07/18)p 1 of 2 !
a,
Public Health Law Sec. 4145(2b) a 14 7 9
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named oil burial permit
Official Funeral Directors Reg.or License#