Sabin, Lydia V E` -} # 9333
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lydia W.Sabin Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/13/2018 51 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Castleton-on-Hudson Street Address Riverside Center For Rehabilitation And Nursing
Manner of Death ffej Natural Cause ❑Accident El Homicide Suicide riUndetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Maximo Valero MD
Address
90 N Main St,Castleton-on-Hudson,New York 12033
Death Certificate Filed District Number Register Number
City, Town or Village Castleton 4124 30
❑Burial Date Cemetery or Crematory
10/17/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
17❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home , 01596
Address
407 Bay Rd,Queensbury,New York 12804
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 10/17/2o1s Registrar of Vital Statistics Padraic Sean Ellis(E(ectronwaftySigned)
(signature)
District Number 4124 Place Castleton, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ID ilt lig Place of Disposition P?„tltiAr
(address)
(section) tot number) c_Th (grave number)
Name of Sexton or Person in Charge of Premises (got number)
I t
(Plea ee print)
Signature 4� Title riL
(over)
DOH-1555(02/2004)