Cuddy, Robbin . -. ill
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name Firikobbin MiddleL LJddy Sex Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/28/2016 56 years War or Dates No
—. Place of Death Hospital, Institution or
ZXTown or 4 Wilton Street Address Meghan Court
0 Manner of Death L. Natural Cause Accident Homicide D Suicide 0 Undetermined pi Pending
la Circumstances Investigation
111 Medical Certifier Name Title
p Michael Sikirica Md
Adtsoad Street Waterford Ny 12188
�Certific�d Wilton Distr4569umber RV ter Number
own or
❑Burial Date 04/01/2016 Cen ter or C�ematory
ine iew errtniMY
❑Entombment Addre
ss
; ['Cremation own Of Queensbury
Date Place Removed
Z ri Removal and/or Held
, and/or Address
..a, Hold
f
0 Date Point of
ftEl Transportation Shipment
ES by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Compassionate Funeral Care, Inc Reg�giin Number
Name of Funeral Home
Addres402 Maple Ave. Saratoga Springs N Y 12866
Name of Funeral Firm Making Disposition or to Whom
I . Remains are Shipped, If Other than Above
Address
L
Permission is hereby granted to dispose of the human remains described above as indicated.
03/30/2016
in Date Issued Registrar of Vital Statistics 7 /4 / n re)
IiiDistrict Number 4569 Place Wilton
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
la Date of Disposition q 14 in, Place of Disposition �?,4 J,., C,.+ teri,,✓
(address)
la
fill
CC (section) (lot number) (grave number)
aName of Sexton or Person in Charge of Premises i4rj will-
2 2 (p, se print)
it[ Signature r^-(, Title
(over)
DOH-1555 (02/2004)