Lazar, Abby NEW YORK STATE DEPARTMENT OF HEALTH \ 4 2( Z
Vital Records Section Burial - Transit Permit
Name Firstbby Middle ' L5t6ar Sex Female
Date of Death AgeIf Veteran of U.S. Armed Forces,
04/03/2016 v1 years War or Dates No
F- Place of Death Hospital, Institution or
5XTown or Nftiffitx Wilton Street Address 704 Saratoga Springs, NY
ilk Manner of Death Q Natural Cause 0 Accident 0 Homicide D Suicide Undetermined 0 Pending
UJ Circumstances Investigation
ta Medical Certifier Name Title
j Michael Sikirica Md
AdgMoad Street Waterford Ny 12188
Certifir Wilton Distr4 5taumber Re1i6ter Number
MI-own or ny
❑Burial Date 04/06/2016 Center�r.or C�emator
itr iew emeter�i
['Entombment Addre
ss
[°Cremation own Of Queensbury
Date Place Removed
Z❑Removal and/or Held
2~ a Hnd/ldor Address
to o
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Date Point of
5 Transportation Shipment
d by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Compassionate Funeral Care, Inc Regieiin Number
Name of Funeral Home
iN Address
402 Maple Ave. Saratoga Springs N Y 12866
Ni Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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9' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/06/2016 Registrar of Vital Statistics �� Xil: ', "��
i District Number 4569 Place Wilton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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ILI Date of Disposition J j 7.l6 Place of Disposition Pill e j p f e%) 6/_yyyl ,j.
2 (address) /
la
W.
IC (section) t number) (grave number)
ta Name of Sexton or son i Charge of Premises h k 0I a-✓t 6 G'Z %-e
Z (please print)
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Signature Title Z...,'e..-mw 'j
(over)
DOH-1555 (02/2004)