Conte, Robert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ` Burial - Transit Permit
0. Name First Middle Last Sex
Robert Conte Male
;:r Date of Death Age ifVeteran of U.S. Armed Forces,
June 2,2017 78 War or Dates
i'gi,. Place of Death Hospital, Institution or
City, Town or Village Queensbury, NY Street Address 7 Fairwood Drive
Manner of DeathIT Natural Cause n Accident Homicide n Suicide ❑Undetermined
MD Pending
Circumstances Investigation
Medical Certifier Name Robert Love Title
f„ Address
Irongate, Glens Falls, NY 12801
1 0 Death Certificate Filed District Number Register Number
fri City, Town or Village Queensbury, NY 5 lr 51 13
El Burial Date Cemetery or Crematory
June 5, 2017 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
' Hold
U)
0 Date Point of
5 n Transportation Shipment
p by Common Destination
Carrier
Date Cemetery Address
PI Disinterment
❑Reinterment Date Cemetery Address
�, Permit Issued to Registration Number
ii Name of Funeral Home Regan Denny Stafford Funeral Home 01443
IAddress
53 Quaker Road, Queensbury,NY 12804
r Name of Funeral Firm Making Disposition or to Whom
1";`} Remains are Shipped, If Other than Above
Address
.,#h. Permission is hereby granted to dispose of the human remains described above as indicated.
,: Date Issued Lj 15 I aa71 `I Registrar of Vital Statistics `- - c,c QD
}`' (signature)
..:Y
i District Number S V 51 Place CCU e. c Sbufj
v
t- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 4/4 f r) Place of Disposition i)/I C cti --
W (address)
U)
0 (section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises t to thn 11F
'Z (plelase print)
Signature
. Title 07011112-
(over)
DOH-1555(02/2004)