Robinson, Richard NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit POrmit
Name First Middle Last Sex
Richard R.Robinson Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/13/2017 72 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death 0T Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Jason Bernad MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 563
❑Burial Date Cemetery or Crematory
11/15/2017 Pine View Crematory
❑Entombment
Address
®Cremation Queensbury Town, New York
3w' Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment •
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tio
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/14/2017 Registrar of Vital Statistics John 2P Tram k Ekctronica1tySigned
(signature)
District Number 4501 Place Saratoga Springs, New York
I
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition fj Ile in Place of Disposition
(address)
trigj
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Pr mises `� 3 4,0 ,14
{ (p/e e print)
Si nature a TitletrpA
ar .
g
(over)
DOH-1555 (02/2004)