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Buser, Robert NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert A. Buser Male Date of Death Age If Veteran of U.S. Armed Forces, 7/2 6/201 7 82 War or Dates Korean ▪ Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death© Natural Cause ❑Accident Homicide ❑Suicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title C Sean Bain MD Address 100 Park Street, Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5 60 ❑Burial Date Cemetery or Crematory 7/31 /2017 Pine View Crematory ❑Entombment Address ['Cremation Queensbury, NY Date Place Removed ❑Removal and/or Held and/or Address IH Hold O Date Point of Li Transportation Shipment O by Common Destination Carrier Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home 01 078 Address 136 Main St. So.Glens Falls, NY 12803 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped, If Other than Above • Address LU-- a" Permission is hereby granted to dispose of the human remains described above" � a 'ndicated. Date Issued 7/31 /201 7 Registrar of Vital Statistics �)CA- ..k..") (signature) District Number 560 f Place G � � �� s l ' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �l/ y W• Date of Disposition 7/3� /•7 Place of Disposition ?/ Ji g (address) UJ £f) IX (section) (lo number) (grave number) pName of Sexton r Person in Charge of Premises tt'a.-1 (��.n 4-4`� C_ z l / (please print) LLI Signature Title (over) DOH-1555 (02/2004)