Robideau,Alice A , ,410 4 ___,,,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Per it
Bureau of Vital Records
Name First Middle Last Sex
Alice A Robideau Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/27/2023 92 Years War or Dates
l— Place of Death Hospital,Institution or
Z City,Town or Village Schroon Town Street Address 38 Fowler Avenue 212,Schroon Town,New York 12870
W
p Manner of Death X❑Natural Cause Accident 0 Homicide []Suicide nUndetermined riPending
W
C.) Circumstances Investigation
W Medical Certifier Name Title
CI Kellie Valentine Coroner
Address
PO Box 132,Elizabethtown Town,New York 12932
Death Certificate Filed Town Of Schroon District Number Register Number
City,Town or Village 1563 7
HBurial Date Cemetery,Crematory or Facility Name
09/28/2023 Pine View Crematory
Entombment Address
[]Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
(.0
0
O. Date Point of
Cl)[]Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
O
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
g Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/28/2023 Registrar of Vital Statistics Patricia Savarieglectronica15,*nea
(signature)
District Number 1563 Place Town Of Schroon
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ 17 N v tie gl+'Ir1 Trii.t n
Z Date of Disposition �IZR Ili Place of Disposition t ��,
2 (address)
W
U)
CC (section) (lotnumber) (grave number)
Name of Sexton or Person in Charge of Pr ggq���i L "' I♦
Z / I(please print)
Z /
W Signature Title
Public Health Law Sec. 4145(2b)
Receipt
Human remains of " „._..._:a.-_._---- delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#