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Lucis, Robert R. , NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert R Lucia Male Date of Death Age If Veteran of U.S.Armed Forces, 01/23/2021 54 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death ©Natural Cause ❑Accident Homicide Suicide �Undetermined El Pending W Circumstances Investigation U WW Medical Certifier Name Title CI Numan Rashid MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number l Register Number City,Town or Village Saratoga Springs 4501 76 ElBurial Date Cemetery,Crematory or Facility Name 01/28/2021 Pineview Crematory El Entombment Address 0 Cremation Queensbury Town,New York Donation OZClRemoval Date Place Removed and/or and/or Held pN Hold Address 0 a Date Point of Cl) Li Transportation 8 by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/25/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 1/Z9 j 1f Place of Disposition t` 2 (address) W N CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premiseslf,, Sy+nnel(j W (ple e print) p Signature Title L fj'�i'Ib T l DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) '14 4 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial pe Official Funeral Directors Reg.or License#