Graska, Rudolf NEW YORK STATE DEPARTMENT OF HEALTH il I SD
Vital Records Section Burial - Transit Permit
i! Name First Middle Last Sex
Rudolf Graska Male
Date of Death Age If Veteran of U.S. Armed Forces,
3/9/2015 75 War or Dates N/A
.1 Place of Death Hospital, Institution or
ZCity, Town or Village Albany Street Address St. Peters Hospital
cl Manner of Death® Natural Cause O Accident O Homicide O Suicide O Undetermined O Pending
Ui Circumstances Investigation
La Medical Certifier Name Title
Q Gregory Bishop M.D.
Address
3 New Hampshire Dr., Troy, NY 12180
Death Certificate Filed District Number Register Number
'' City, Town or Village Albany 101
< OBurial Date Cemetery or Crematory
03/15/2015 Pineview Crematory
Entombment Address
®Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
2 and/or
f;; Address
Hold
0 Date Point of
Q Transportation Shipment
6 by Common Destination
Carrier
O Disinterment Date Cemetery Address
liiiii!O Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc. 00364
Address
402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Z
tii
7' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3 fZ// Registrar of Vital Stati . Q__�
( (signature)
Ai District Number Place
il-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3/Iblic Place of Disposition „20 O,.. (,44-j '
(address)
III
fia
t= (section) (lot numb (grave number)
4
C1 Name of Sexton or Person i.p harge of Premises i►" � N`�1
�► ease print) •
5 i f1w1
: Signature �, Title 04
(over)
DOH-1555 (02/2004)