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Mitchell, Robin Hensley IF i-1( NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robin Hensley Mitchell Female Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2022 60 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Saratoga Springs Street Address Saratoga Hospital `LJ p Manner of Death © Natural Cause ElAccident Homicide Suicide ❑Undetermined ElPending U Circumstances Investigation W Medical Certifier Name Title CI Enrico Bravo MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 140 ElBurial Date Cemetery,Crematory or Facility Name 02/25/2022 Pine View Crematorium ❑Entombment Address lCremation Queensbury Town,New York IDDonation • Removal Date Place Removed and/or and/or Held Hold Address 0 O. Date Point of U) ❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home William J Burke&Sons Funeral Home 01827 Address 628 N Broadway,Saratoga Springs,New York 12866 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/24/2022 Registrar of Vital Statistics (Dillon Moran(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: IH Z Date of Disposition a—aG....242.z. Place of Disposition �t`Ae 1,4 1-44' IJJ 2 (address) W NfE (section) ( t number) (grave number) f Name of Sexton or Person in Cha of Premis > A��0�v na) Z (please print) W Signature Title �� r DOH-1555(07/18)p 1 of 2 r �9 1M Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#