Vicchiullo, Lucille �R � II
YORK STATE DEPARTMENT OF HEALTH Burial - TransitPermit
Vital Records Section ;'
/
Name First Middle .-°' Last Sex
Lucille Vicchiullo Female
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 16 / 2015 90 War or Dates N/A
;H Place of Death Hospital, Institution or
Z City, Town or Village Northumberland Street Address 9 Cherry Lane
ci Manner of Death®Natural Cause E Accident 0 Homicide Suicide D Undetermined Pending
Circumstances Investigation
til Medical Certifier Name Title
0 Tanya J. Finch NP
Address
1205 T::, y Schenectady Rd., Latham, NY 12110
.. Death Certificate Filed District Nu r '� y,, Register Number
City,Town or Village Northumberla ('f
OBurial Date /a///� - Cemetery or Crematory `1
Mi
Entombment Pine View Crematory
Address
ECremation Queensbury, Ny
Date Place Removed
2❑Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
In
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
iiii!,; Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
ili'?lii 402 Maple Ave. , Saratoga Springs, NY 12866
i € Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
Ili
"` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued ctI L1 15 Registrar of Vital Statistics
iiig (signatu e)
.4/131131-t-
i District Number y0(03 Place Northumberland , New York
TM
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tti Date of Disposition 1/23115' Place of Disposition ,0041),...) C tcf,,,,,,..
2 (address)
iii
(section) (lot number) (grave number)
t Name of Sexton or Person in Charge of remises •. G t r•% S2`w 'f
t (please print) •
Signature A'
Title lel:Mtiv
(over)
DOH-1555 (02/2004)