Loading...
Robinson, John -f 1i' 3S'l NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex John F. Robinson Male Date of Death Age If Veteran of U.S. Armed Forces, 04 / 28 / 2018 74 War or Dates Zq }- Place of Death Hospital, Institution or 2 City, Town or Village Milton Street Address 479 Rowland Street g Manner of Death®Natural Cause �Accident 0 Homicide E Suicide -1 Undetermined �Pending W0. . Circumstances Investigation at Medical Certifier Name Title John Pezzulo DO Address 112 Charlton Rd, Ballston Lake, NY 12019 >> Death Certificate Filed District Number y 5 p t ' Register Number S City, Town or Village Milton <> fBurial Date Cemetery or Crematory 04 / 30 / 2018 Pine View Crematory iiiiiii 0 Entombment Address Cremation Queensbury, NY Date Place Removed 0❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment Ea by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Ei Permit Issued to Registration Number [' Name of Funeral Home Compassionate Funeral Care 00364 Address '>'4 402 Maple Ave., Saratoga Sp. , NY 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address I Permission is hereby granted to dispose of the human re.—ins describe a e as indicated. iiiii Date Issued t l3 © I t Registrar of Vital Statistics i � ' 1 (signature) District Number 451 p Place Milton , New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 5/z I IT Place of Disposition et.., .,� rpArRocton, (address) Ill IC (section) (ot numbre ll ) (grave number) Ct CI Name of Sexton or Person in Charge of P emises L. pl.,- Sz-,r ase print) VIL ii (plent) . Signature Title jf1,I (over) DOH-1555 (02/2004)