Lombardo, Frances NEW YORK STATE DEPARTMENT OF HEALTH 0100
Vital Records Section Burial - Transit Permit
Name Fist Middl� Lombardo Seemale
Date of Death Age If Veteran of U.S. Armed Forces,
02/24/2013 82 years War or Dates
1.. Place of Death Hospital, Institution or
ZCity, WF-Koe Saratoga Springs Street Address Saratoga Hospital
G1 Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
L Circumstances Investigation
ILI Medical Certifier Name Title
O. Rodney Ying MD
g
r►V yrtle Street Saratoga Springs, Ny
Death Certificate Filed District Number ' Register Number
City, ifvitaonigffe Saratoga Springs 4501 105
'' ❑Burial Date Cemetery or Crematory
02/26/2013 Pine View Crematory
❑Entombment Address
• ;;;;; ]Cremation •Queensbury N Y •
Date Place Removed
2❑Removal and/or Held
and/or
i;,k Address
'I)
Hold
O Date Point of
0" Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
O
Reinterment Date . Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y 12866
•
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
• Address
i
til
Permission is hereby granted to dispose of the human remains de cribed above as indicated.
Date Issued 02/25/2013 Registrar of Vital Statistics C., 0—Qn, 12:4-En44Jk
(signature)
iiip 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:
ta• Date of Disposition Z'ti,l3 Place of Disposition �r,.4i fI f.---
(address)
Ili
t
IX (section) otnumber) c (grave number)
tz Name of Sexton or Person in Charge f Premises �r'J 1 pIL.- Jtm*
(p/ea3e print)
ta
Si nature Title 02 'RA, _. __
9
(over)
DOH-1555 (02/2004)