Rudio, Gregory 41
NEW YORK STATE DEPARTMENT OF HEALTH %0
Vital Records Section r N, Burial - Transit Permit
Name First Middle Last Sex
Gregory Alan Rudio Male
Date of Death Age If Veteran of U.S. Armed Forces,
55 years War or Dates
i- PN ��ath Hospital, Institution or
Z City, Town or Villa a Amsterdam Street Address St. Mary's Healthcare .
WMannPelf��Natural Cause Accident Homicide Suicide 0 Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C
paWir&ggah Benoit MD
425 Guy Park Avenue, Amsterdam, New York 1201d
Death Certificate Filed District Number Register Number
City, Town or Villa e
XXXX C Amsterdam 2801 231
❑Burial Cemetery or Crematory
['Entombment Addr sI18/2012 Pine View Crematory
❑Cremation
Date Queensbury, Ncw York Place Removed
Removal and/or Held
2 and/or Address
'I)
Hold
0 Date Point of
%❑Transportation Shipment
C3 by Common Destination
Carrier
Disinterment Date Cemetery Address
•
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M b. Kilmer Funeral Home 01077
Address q
Name of i-uneral Frmtivlaranlg'Dispositionlor8to Whom
1-- Remains are Shipped, If Other than Above
2 Address
Z
W .
a' Permission is hereby granted to dispose of the human rem s escribeda vd-as indic
Date Issued Registrar of Vital Statistics ., V
09/17/2012 O 0 _
(signature)
District Number Place
2801 Amsterdam
I-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition et- 1-IZ Place of Disposition 2610,4) G c-ti,.--,
W (address)
CC (section) / _ (lot number) j, (grave number)
Q Name of Sexton or Per .n in Charge f Premises l7/i.i rt.^hl�t
2 ZNP1
( lease print)
SILI ignature Title C frit nJ4r06.
(over)
DOH-1555 (02/2004)