Garcia, Robert NEW YORK STATE DEPARTMENT OF HEALTH y 1 0
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert E Garcia Male
Date of Death Age If Veteran of U.S. Armed Forces,
01/28/2016 33 years War or Dates 2000-2003
Place of Death Hospital, Institution or
City, TdWHC�r T41 C Glens Falls Street Address Glens Falls Hospital
Iti0 Manner of Death❑Natural Cause 0 Accident n Homicideuicide El Undetermined ri Pending
Circumstances Investigation
rj Medical Certifier Name Title
0 Michael Sikinrca M D
Address
50 Broadway Waterford, N Y 12188
Death Certificate Filed District Number Register Number
!> City, Tc r(&VW Glens Falls 5601 52
❑Burial Date Cemetery or Crematory
02/03/2016 Pine View Crematorium
❑Entombment-Address
[3Cremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
9.❑and/or Address
F Hold
0 Date Point of
ili El Transportation Shipment
G't by Common Destination
id Carrier
Q Disinterment Date Cemetery Address
•
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
ni
Address
402 Maple Street Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
14, Remains are Shipped, If Other than Above
Address
2
t
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/01/2016 Registrar of Vital Statistics LA) W—^��
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iii Date of Disposition a-.3--t e Place of Disposition p i 1,, y i _, i C,it vi ct.�.Qr y
(address)
tti
r (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises sl Z.cm¢,j' S t,ms pa-5
2 (please print)
3 y Signature ., -t Title Gft,>"+)rc(
(over)
DOH-1555 (02/2004)