Briggs, Lucia NE/1/YOIR"k STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lucia N Briggs Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/02/2011 87 years War or Dates No
j- Place of Death Hospital, Institution or
City, gp�/Tov Schenectady Street Address Ellis
a Manner of Deathatural Cause Accident Homicide Suicide 0 Undetermined Pending
Ltt Circumstances Investigation
tu Medical Certifier Name Title
id Sergey Gorbachev M D
Address
1101 Nott St, Schenectady, N Y 12308
Death Certificate Filed District Number Register Number
V4601Ci , ToyptxVi Ix Schenectady
493
L"J�urial Date Cemetery or Crematory
['Entombment06/06/2011 , Pineview Cemetery
Address
•
❑Cremation Queensbury, New York •
Date Place Removed
Z Removal and/or Held
2 El and/or Address
~` Hold
IA
0 Date Point of
tiai❑Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Catricala Funeral Home 00798
Address
1597 Rte 9, Clifton Park, New York
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
111
1' Permission is hereby granted to dispose of the human rentals 'escrikie,d ab a as Indic ed.
L Date Issued 06/03/2011 Registrar of Vital Statistics ,' tij t,k. k; 7L1
(signature)
•
District Number 4601 Place Schenectady
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iF:
Z Pine View Cemetery
tii Date of Disposition 6/6/11 Place of Disposition
2 (address)
WCA Uncas 421 Sec. 22 6
ft (section) (lot number) (grave number)
Name of Sexton or Person i arge of Premises Michael Genier
(please print)
ILI Signature � r�� frY*-4-44-' Title Superintendent
(over)
DOH-1555 (02/2004)