Irwin, Robert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Gordon Irwin Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/08/2014 73 years War or Dates
Place of Death Hospital, Institution or
W City, ToptxXxVjfIXX Saratoga Springs Street Address Sarato a Hospital
Manner of Death❑flatural Cause ❑Accident ElHomicide ❑Suicide Undetermined ❑Pending
iii Circumstances Investigation
Vtt Medical Certifier Name Title
i
L1 Mikhail Mavashev M n
Address
211 Church Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
City, Top4XXXK\44X (X Saratoga Springs 4501 272
i ❑Burial Date Cemetery or Crematory
['Entombment Address
Pine View Crematory
Address
❑cremation Schenectady, N Y
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
,. Hold
to
C3 Date Point of
0 Li Transportation Shipment
0 by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
eli Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
iiig Address
402 Maple Ave., Saratoga Springs, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
f
Luu
97 Permission is hereby granted to dispose of the human remain "be,�ab� " dicated.
Date Issued 06/09/2014 Registrar of Vital Statistics 1`�►L�M
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1.
2
LV Date of Disposition (-1 Place of Disposition ZijiAJ ; _a(io .
2 (r (address)
ill
CC (section) r (lot nu ) (grave number)
p Name of Sexton or Person i Charge of Premises it
u o+ G
17(please print)
111 ure Title T�� tat
Signature
(over)
DOH-1555 (02/2004)