Papps, Stephen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex Male
Stephen Jon Papps
Date of Death Age If Veteran of U.S. Armed Forces,
02/28/2017 45 years War or Dates
j Place of Death Hospital, Institution or
City, To CX Mechanicville
i Street Address 2 Harris Ave., Apt. E3; Mechanicville, N Y 12116
0 Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑ Undetermined ❑,Pending
LLt Circumstances Investigation
W Medical Certifier Name Title
IP Michael Sikirica M.D.
Address
50 Broad Street; Waterford, NY 12188
Death Certificate Filed District Number Register Number
City, Towibj(iIXX Mechanicville 4523 3
❑Burial Date Cemetery or Crematory
03/03/2017 Pine View Cremator/
❑Entombment Address
❑CQemation Queesbury, New York
Date Place Removed
Z ❑Removal and/or Held
3 and/or Address
H Hold
Cl)
O Date Point of
ai 0 Transportation Shipment
O by Common Destination
Carrier
❑Disinterment Date Cemetery Address
•
❑Reinterment Date Cemetery Address
Permit Issued to RegistrttivIalumber
Name of Funeral Home M. B. Kilmer Funeral Home
Address
82 Broadway; Ft. Edward, N.Y. 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
IX
to
fl" Permission is hereby granted to dispose of the human r ns escri ed ov as in c ed.
Date Issued 03/02/2017 Registrar of Vital Statistics
(signature)
District Number 4523 Place Mechanicville
I certify that the remains of the decedent identified above were disposed of in accordancewith this permit on:
t� .3• Date of Disposition '31)7 Place of Disposition 'Cot VRtw iitr�C'rfu rt s-"
2 (address)
id
U)
CC (section) /(otnumber) ( (grave number)
2 Name of Sexton or Person in Charge of Premises / 1i. L-t J +`tt
Z (plea a print)
Signature del -/� Title 05€.11^1)0A—
(over)
DOH-1555 (02/2004)