McCarthy, Robin A. " I/
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robin A.McCarthy Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/29/2020 60 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Wilton Town Street Address 85 Traver Road,Wilton Town,New York 12831
0 Manner of Death El Natural Cause ❑Accident ❑Homicide 0 Suicide ❑Undetermined ❑X Pending
IL Circumstances Investigation
W Medical Certifier Name Title
0 David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 47
Burial Date Cemetery,Crematory or Facility Name
11/02/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
N Transportatign Shipment
0 by Common
Carrier Destination
❑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,New York 12866
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
g Address
CC
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/02/2020 Registrar of Vital Statistics Swan Ballwin(ffE/ctronrcafSigned)
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 04 iv Place of Disposition I "
2 (address)
W
CC
CC (section) lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises �� " '�"�l}(
(plea a print) /1
W Signature ` Title ` �
DOH-1555(07/18)p 1 of 2
.� 3
Public Health Law Sec. 4145(2b) 14. �
Receipt
Human remains of = ' ' delivered on , 20
•
f i
Pine View Cemetery 1 epresenting the funeral home named on burial permit
Official Funeral Directors Reg.or License#