Loading...
Stubing, Lisa NEW YORK STATE DEPARTMENT OF HEALTH * �J / / Vital Records Section 4 Burial - Transit Permit • * Name First Middle Last Sex .4- Lisa Ann Stubing Female 4:':" Date of Death Age If Veteran of U.S. Armed Forces, 74 E July 28,2014 58 War or Dates %` Place of Death Hospital, Institution or �ta Z, City, Town or Village Saratoga Springs Street Address Saratoga Hospital & Nursing Home Manner of Death X Natural Cause n Accident Homicide Suicide Undetermined Pending W; — Circumstances Investigation Medical Certifier Name Title Mark Weidner ° Address ` Saratoga Hospital,Saratoga Sp rings,ring s,NY 12866 n; Death Certificate Filed District Number Register Nymber : ; City, Town or Village Saratoga 4501 33LQ ❑Burial Date Cemetery or Crematory July 29,2014 Pine View Crematory ❑Entombment Address ©Cremation 21 Quaker Rd.,Queensbury,NY 12804 Date Place Removed Z ' Removal and/or Held and/or Address F Hold rn O Date Point of N I 1 Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address .r: Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 : , Address %,' 3809 Main Street,Warrensburg,NY 12885 is w' Name of Funeral Firm Making Disposition or to Whom K Remains are Shipped, If Other than Above 2 Address U, • r Permission is h reby ranted to dispose of the human remade cri d ably indicat . : r ;:•. Date Issued Registrar of Vital Statistics : (signature) 4501 Saratoga District Number Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W t'Date of Disposition �3o Place of Disposition /9711,‹ V 1/ / pAi W (address) cn (section) �fgot number) (grave number) z Name of Sexton o e on i ge of Premises /Jo/ W C,�� (please print) lir/ Signature �.i� Title /!e--- (over) DOH-1555(02/2004)