Streicher, Richard 4 Ilk
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Richard Joseph Streicher Male
r= Date of Death Age If Veteran of U.S. Armed Forces,
11/18/2018 65 Years War or Dates 1970-1973
9 Place of Death Hospital, Institution or
• City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death x Natural Cause Accident I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Jennifer White DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
• City, Town or Village Saratoga Springs 4501 607
E Burial Date Cemetery or Crematory
11/26/2018 Pine View Crematory
Entombment Address
[C Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipmentby Common Destination
rg Carrier
1 Disinterment Date Cemetery Address
}
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
ITS
-,TA Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/20/2018 Registrar of Vital Statistics John P Franck(cEfectronicallySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
-4 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition j!-aG4-1y Place of Disposition .1);,,,t,V; c,rt - tor)/
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 7:1S)v*.y S ems
(please print)
Signature Title ( ftr-S 1-c 1
(over)
DOH-1555 (02/2004)