Trapp, Robert -�)4 it17)
NEW YORK STATE DEPARTMENT OF HEALTH s� Burial - Transit Permit
Bureau of Vital Records s
I --
Name First Middle Last Sex
Robert Trapp Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/14/2021 62 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death 0 Natural Cause ❑Accident ❑Homicide 11 Suicide ❑Undetermined ❑Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
CI Jennifer Tchervenkov MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0768
0 Burial Date Cemetery,Crematory or Facility Name
03/16/2021 Pine View Crematory
ElEntombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Date Place Removed
ZO ❑Removal and/or Held
— and/or
N
- Hold Address
0
d Date Point of
(I) Li Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
ElDisinterment
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
1— Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/16/2021 Registrar of Vital Statistics Dania&SCj'illerpre(EYectronicall:ySlgne4
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— II'I /_
Z Date of Disposition 3111 I Z I Place of Disposition ?IL �'!00---
W 2 (address/
ILl
N CC (section) (lot number) (grave number)
Sexton or
0 Name of Personin Char a of Premises A t`f tt," S..;s°"4'tT
z (pleasi►print)
ii
W Signature Title 6-0',"W0/0
DOH-1555(07/18)p 1 of 2
.4"
Public Health Law Sec. 4145(2b) , 1.4646
2
Receipt
Human remains of ' '72 ,delivered on I ,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#