Pratt, Robert NEW YORK STATE DEPARTMENT OF HEALTH I
Vital Records Section • Burial - Transit Permit
Name First Middle Last Sex
Robert Merton Pratt Male
' Date of Death Age If Veteran of U.S. Armed Forces,
1' July 22. 2006 73 War or Dates
Z Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
G Manner of Death E Natural Cause 0 Accident 0 Homicide 0Suicide 0 Undetermined 0 Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Dr. Orlando J. Martelo, M.D. Dr.
0 Address
102 Park St., Glens Falls, NY 12801
Death Certificate Filed District Number Registe umber
City, Town or Village Glens Falls . / .a
Date Cemetery or Crematory
❑Burial July 24. 2006 Pine View Crematorium .
Address
Q Cremation Ouaker Road Oueensburv, NY 12804-
Date Place Removed
0 0 Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 0 Transportation Shipment
Q by Common Destination
0 Carrier
o- ❑ Disinterment
Date Cemetery Address
ciiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
ce Remains are Shipped, If Other than Above
W Address
0.
Permission is her y ranted to dispose of the human mains d scribed a ove as indic d.
Date Issued Registrar of Vital Statistics 4
(signature)
District Number 57061 Place Glens Falls,New Y k
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition Place of Disposition
2 (address)
w
0
Et (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises
w (please print)
Signature Title