Francisco, Ruby NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
Ruby K. Francisco Female
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 12 / 2015 64 War or Dates N/A
1- Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death®Natural Cause 0 Accident 0 Homicide E Suicide Undetermined �Pending
IliCircumstances Investigation
la Medical Certifier Name Title
0 Andrij Baran MD
Address
6 Care Ln Saratoga Springs, NY 12866
Death Certificate Filed District N mber Register,Nilm r
City, Town or Village Saratoga Springs L'c5'i �/
QBurial Date Cemetery or Crematory
09 / 17 / 2015 Pine View Crematory
Entombment Address
Nii pCremation 21 Quaker Road, Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
': Q Reinterment Date ' Cemetery Address
;i 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
Permission is her y g nted to dispose of the human rema' or' ed of indicate .
Date Issued Ji-' �5 Registrar of Vital Statistics
(signature)
District Number q 6.01 Place Saratoga Springs , New York
M.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z '{ /�`
W. Date of Disposition q j Ic1t'C Place of Disposition ?.101,..../ [ rocw^^
a' (address)
w
i (section) (lot number (grave number)
Name of Sexton or Pers n in Charge of Premises A;S C N..4O
Z • lease print) •
Signature Title ((? 01 �jr-
9 �t
(over)
DOH-1555 (02/2004)