Karpinski, Vivian *114
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Vivian Karpinski Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/06/2016 91 years War or Dates
}- Place of Death Hospital, Institution or
City, Town or Village City of Poughkeepsie Street Address River Valley Care Center
W Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
M Akhter M D
Address
1285 Rte 9 Suite 13, Wappingers Falls, N Y 12590
Death Certificate Filed District Number Register Number
City, T EdAr NYWEX Poughkeepsie 1302 129
❑Burial Date Cemetery or Crematory
02/09/2016 Pine View Crematorium
El Entombment Address
Cremation Queensbury, N Y
Date Place Removed
Z❑Removal and/or Held
and/or Address
l= Hold
O Date Point of
❑Transportation Shipment
ct by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑ •Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. A. Connell Funeral Home, Inc. 01073
Address
934 New York Avenue, Huntington New York
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above M.b Kilmer Funeral Home- Fe
Address
82 Broadway, Ft. Edward N Y
a. Permission is hereby granted c• diS ose of the huma ains describ d abo as i icated.
1111
Date Issued 02/08/2016 istr of Vital Statistics C T Y(
(signature)
District Number 1302 Place City of Poughkeepsie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition Z-Icy:-i& Place of Disposition pl fit, c,roivicifor y
(address)
(section) (lot number) (grave number)
CI eiS
Name of Sexton or Person in Charge of Premises 3—e,t Y (N. ;t'
► (please print)
Signature I Title G f't,jy 36
(over)
DOH-1555 (02/2004)