Piccone, Rose NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rose Ann Piccione Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 06, 2014 86 War or Dates
I--. Place of Death Hospital, Institution or
W City, Town or Village Amsterdam Street Address St Mary's Hospital
a Manner of Death Natural Cause Accident Homicide Suicide 0 Undetermined 0 Pending
LU Circumstances Investigation
ui Medical Certifier Name Title
❑ Jeffrey D. Hubbard, MD Deputy Coronor
Address
19 Warehouse Row,Albany, NY
Death Certificate Filed Amsterdam District Number Register Number
City, Town or Village 2801 149
}❑Burial Date Cemetery or Crematory
June 10,2014 Pineview Crematory
4❑Entombment Address
®Cremation Queensbury, NY
ZDate Place Removed
Z ❑Removal and/or Held
and/or Address
Hold
U)
0 Date Point of
CL
co❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
❑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
H Remains are Shipped, If Other than Above
E Address
tY
W
a Permission is hereby granted to dispose of the human remai s described ab e s indicate
Date Issued June 09,2014 Registrar of Vital Statistics
nature) 0 O. .
District Number 2801 Place City of Amsterdam
I certify that the remains of the decedent identified above were disposed of in accordance/ with this permit on:
LU Date of Disposition j^!+—tL i) C4 Place of Disposition 4 VArfo(
(address)
LU
CO
re (section) %(fo&numb (grave number)
pp Name of Sexton or Person i Charge of Premises .___ Iikti
Z (please print)
LU
Signature 13— Title CIM"►
(over)
DOH-1555 (02/2004)