Robinson, Kathy if
NEW YORK STATE DEPARTMENT OF HEALTH 7��
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kathy Robinson Female
Date of Death Age If Veteran of,U.S. Armed Force ,
10 / 31 / 2016 69 War or Dates �,
}• Place of Death Hospital, Institution or 111
WCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death iE Natural Cause 0 Accident ❑Homicide ❑Suicide FlUndetermined ri Pending
f Circumstances Investigation
jla Medical Certifier Name Title
O Qiong Wang MD
Address
211 Church St, Saratoga Springs, NY 12866
gii Death Certificate Filed District Number Register Number
>`> City, Town or Village Saratoga Springs V S C( ' e j
»'< ®Burial Date Cemetery or Crematory /
11 / 01 / 2016 Pine View Crematory
>' EntombmentWS Address
;iia O Cremation Queensbury, NY
' ' Date Place Removed
Removal and/or Held
.� and/or Address
Hold
3 Date Point of
Q Transportation Shipment
Et by Common Destination
Carrier
Q Disinterment Date Cemetery Address
::::li Date Cemetery Address
iiiMQ Reinterment
€s Permit Issued to Registration Number
iiA Name of Funeral Home Compassionate Funeral Care 00364
>': Address
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
IU
`. Permission is he b granted to dispose of the human rem ' cr' d aim indicate .
lie
: Date Issued Registrar of Vital Statistics t
(signature)
ig
!igi District Number Ys 01 Place Saratoga Springs , New York
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tiit Date of Disposition ij/t I Lb Place of Disposition gwUt..,- (ryy4 ,1
(address)
iii
Cil
CC (section) //I/ (lot number), (grave number)
0 Name of Sexton or Person in Charge of Premises /443 (1� J€14 i '
z �' rpiease print)
• Signature Title ( (19(t-
•
(over)
DOH-1555 (02/2004)