Stanford, Robert NEW YORK STATE DEPARTMENT OF HEALTH t
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Stanford Male
Date of Death Age If Veteran of U.S. Armed Forces,
06 / 12 / 2018 65 War or Dates N/A
}- Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address 82 Crescent St., Apt 2
aManner of Death®Natural Cause 0 Accident Homicide 0 Suicide �Undetermined Pending
Circumstances Investigation
til Medical Certifier Name Title
P. Michael Sikirica MD
Address
50 Broad St, Waterford, NY 12188
Death Certificate Filed District Number ���I Register Ny;ntr
'i City, Town or Village Saratoga Springs
EIBurial Date Cemetery or Crematory
06 / 18 / 2018 Pine View Crematory
0Entombment Address
ECremation Queensbury, NY
Date Place Removed
Z a Removal and/or Held
m. and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
ARili Carrier
El Disinterment Date Cemetery Address
1 Date Cemetery Address
Q Reinterment
<' Permit Issued to Registration Number
ii5i Name of Funeral Home Compassionate Funeral Care 00364
Address
iiiiq 402 Maple Ave., Saratoga Sp. , NY 12866
iiK of Funeral Firm Making Disposition or to Whom
tRemains are Shipped, If Other than Above
Address
5
> Permission is her by g anted to dispose of the human rem ' sc ' ed ve indicat d.
Date Issued (p J ,�j ^ Registrar of Vital Statistics
(signature)
Uii
District Number 1 5°I Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
iii Date of Disposition it/to jig Place of Disposition 1mAL j
NE (address)
in
VA
(section) (194 number) (grave number)
0 Name of Sexton or Person in Charge of Premises [1 Ss•N
Z • 'i (pleas print) •
Signature �^ Title !r' r}
(over)
DOH-1555 (02/2004)