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Reynolds, Peter A.
- 4 11 3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peter A.Reynolds Maio Date of Death Age If Veteran of US.Armed Forces, 01/27/2021 62 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Saratoga Springs Street Address Saratoga Hospital j Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Sergio Lema-Gutierrez MD Address 211 Church St,Saratoga Springs,New York 12888 Death Certificate Filed District Number Register Number CA ,Town or Ville Saralo9a Sprin 4501 94 Burial Dale Cemetery,Crematory or Facility Name 01/28/2021 Plne View Crematory El Entombment Address QCremation Queenabury Town,New York Donation p❑Removal Date Place Removed F and/or and/or Held 0 Hold Address Cl)❑Transportation Date Point of a 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 12688 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address W CL Permission Is hereby granted to dispose of the human remains described above as Indicated. Date Issued 01/28/2021 Registrar of Vital Statistics ,o eOu<fraack(Elschoxuali5,50 df (s(arararrl 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 Date of Disposition 2 I(it, Place of Disposition �. i feadreul IL (secrwn/ [ (tot number) (grave number) gName of Sexton or Person in Charge of Pre ' 1� ''`tpL .S b 4Ir i�+_— !pl a print) W L r F414 Signature s Title DOH-1555(07/18)p tat 2 TO 39Vd Vd3Nf1J 31VNOISSVdWOO Eb8bb868TS 6bcb1 TZOZ/6Z/T0 LOO'd £t,QbtrSSBLS SV:ti. IZOZ/6Z/L0 ewl1/94ea Xa 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#