Martucci, Robert ' , 4 gi2.
I
NEW YORK STATE DEPARTMENT OF HEALT
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
Robert P. Martucci Male
'- Date of Death Age If Veteran of U.S. Armed Forces.
1 0/2 9/2 01 7 9 2 yr s. War or Dates 19 43-1946
ig Place of Death Town of Hospital. Institution or 8074 Lakeshore Drive
City, Town or Village Hague Street Address Silver Bay
40
0 Manner of Death Q Natural Cause 0 Accident 0 Homicide 0 Suicide ElUndetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Address S- is i��er Hoy At. b .
)61 ecu-Ey 'Roct.(' Z Ira. One o QikeerNsb -y, . )-y I OL/
Death Certificate Filed Town of Hague District tuber Register Number
>< City, Town or Village 5653
Date Cemetery or Crematory
iii ❑Burial 10/31 /2017 Pine View Crematory
Address
::: OCremation Queensbury, New York
Date Place Removed
2 ❑Removal and/or Held
n and/or Address
Hold
0 Date I Point of
NTransportation I Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address •
Reinterment ' Date Cemetery Address •
i Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01821
>' -Address
- 11 Alcpnkin St .i Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom .
-t, Remains are Shipped. If Other than Above
2 Address
f
c
gii Permission is hereby granted to dispose of the human r ains described bove as indicated. ff��
Date Issued 1 0/3 0/201 7 Registrar of Vital Statistics alC ` 'A %' t'p L)-I l.?
(signatur
District Number 5653 Place Town of Hague
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f- n
Date of Disposition II /I in Place of Disposition f n:11-w •.q,. D �,
2 (address)
LU .
U
CC (section) t/ (lot number (grave number)
GName of Sexton or Person in Charge of PreJnises �1 r. r^ r��� '
(please print)
Signature Title [MA n�7p�
DOH-1555 (10/89) p. 1 of 2 VS-61
i