Trieste, Lucille ! A3b
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lucille Joy Trieste Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/1 0�4 85 years War or Dates
i— Place ofea h Hospital, Institution or
Z City, To Street Address
ILU � arato a ins W slcW Manner oDeionX Natural Cause LAcident ❑Homicide ❑SuicideF � b Pending
Circumstances Investigation
W Medical Certifier Name Title
la
AA/Mew C. Pender M D
131 Lawrence Street, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, To vimX Saratoga Springs 4r 202
❑BurialDirafr Cemetery or Crematory
['Entombment Address/17/2014 Pine View Cemetery
Cremation Queensbury N Y
Date Place Removed
F.: Removal and/or Held
✓ and/or
� Address
in
Hold
O Date Point of
8" Transportation Shipment
G! by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
Name -4f0 FMnra leqqv a kmSa rDtioas S ornn s toWYh o2m6
1,4 Remains are Shipped, If Other than Above
• Address
it
ILI
fl` Permission is hereby granted to dispose of the human rem - scr ed ab ve as indicated.
Date Issued 06/17/2014 Registrar of Vital Statistics 1Jj(�q,
(signature)
District Number Place
4501 Saratoga Springs
I.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
la Date of Disposition 6//iM Place of Disposition ?u1 C-i„, ,,...—
(address)
III
tfl
IX (section) (lot/ mber) (grave number)
ci Name of Sexton or Person in Char a of Premises `^�� �"�" `
z► / (please pn )
Signature I, _ Title c2' ;t
(over)
DOH-1555 (02/2004)