Zipkin, Maureen NEW YORK STATE DEPARTMENT OF HEALTH - , 7g
Vital Records Section Burial - Transit Permit
iiM Name First Middle Last Sex
ig Maureen Teresa Zipkin F
Mi Date of Death Age 1 If Veteran of U.S. Armed Forces,
iiii Oct. 29, 20151 51 War or Dates 1 9 81 -8 3
'14 Place of Death I Hospital, Institution or
Z City, Town or VillageCity of Albany -Street Address St. Peter' s Hospital
1 Manner of Death ❑ Natural Cause ❑Accident E Homicide ❑Suicide ❑ Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
41 Michaelg Sikirica MD
1 ?press
State Street. , Albany, NY 12207
Death Certificate FileLty of Albany ' Districlhimber 1 Register Number
iii!ii' City. Town or Village I
Date I Cemetery or Crematory
❑ Burial 1 1 /02/201.5 Pine View Crematory
xr Address Queensbury, NY
_Cremation i
gDate Place Removed
Z ❑Removal j and/or Held
and/or Address
re--. Hold
Q Date Point of
N ❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
i Paiiiermit Issued to Compassionate Funeral Care Regist igr Number
Name of Funeral Home
Address 402 Maple Ave. , Saratoga Springs, NY 12866
'<. : Name of Funeral Firm Making Disposition or to Whom
sit Remains are Shipped. If Other than Above
Address
i
l.i Permission is hereby granted to dispose of the human remains escribed�l2��Q as indicated.
>< Date Issued !D 3/- o/S� /i
Registrar of Vital Statistics A ' 1-'..1 z/i. �
(signature)
District Number101 Place Albany Police Department Albany. NY
in
I certify that the remains of the decedent identified above were disposed of in accordance+ with this permit on:
WDate of Disposition Ii I3//S Place of Disposition 42001 i14 Cr+y,1 or,. ...
2 (address)
LU
CC (section) // (lot number) (grave number)
flName of Sexton or Person in Charge of Premises G4t,: .- 440
g (please print)
Pi.! Signature Title lf414
(over)
DOH-1555 (9/98)