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Rudnick, Abraham NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Abraham Z. Rudnick Male Date of Death Age If Veteran of U.S. Armed Forces, February 3, 2012 85 War or Dates No t,., Place of Death Hospital, Institution or Z City, Town or Village Queensbury Street Address 9 Rudley Dr. O Manner of Death I XI Natural Cause I 'Accident 'Homicide Suicide Undetermined Pending Ili Circumstances Investigation `i t Medical Certifier Name Title O -�It,g.E.,,,A et-IdA.,iL k /1,57 Address Death Certificate Filed District Nu ter Register Number City, Town or Village Queensbury 5657 , 9D ©Burial Date Cemetery or Crematory February 5, 2012 Shaaray Tefila ❑Entombment Address ❑Cremation Media Drive, Queensbury, NY 12804 Date Place Removed Z I I Removal i and/or Held and/or Address F' Hold N o Date 1 Point of N1 I Transportation Shipment p' by Common Destination Carrier (Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton-Healy Funeral Home 01596 Address 407 Bay Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above N Address rt 0" Permission is hereby granted to dispose of the human rem§itis described above indicated. Date Issued a - "3- Pot 1.- Registrar of Vital Statistics 1 b.-..s�.P•- — (signature) District Number 5657 Place Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition -/4//2 Place of Disposition Sg 4;,<),� 7—< r"", 1 . I' Or, k W - (address) 1" CO re (section) (lot number) (grave number) p• Name of Sexton or P rson in Charge of Premises W �` (please print) Signature ' Title - (over) DOH-1555(02/2004)