Ryan, Robert NEW YORK STATE DEPARTMENT OF HEALTH 00
Vital Records Section Burial - Transit Permit
Name First Middle - Last Sex
Robert Eric Ryan •
Date of Death Age If Veteran of U.S. Armed Forces,
3-2 4-2 01 4 55 War or Dates NO
. Place of Death South Glens Falls Hospital, Institution or 1 Jackson Ave.
WCity, Town or Village Street Address
a Manner of Death 0 Natural Cause El Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
ili Medical Certifier Name Title
a Williamgq� Parker MD
48 East St. FortdWaward, New York 12828
Death Certificate Filed Grath Glens Falls District Number Register Number
City, Town or Village _
❑Burial Date Cemetery or Crematory
3-26-2014 Pine View Crematory
HI❑Entombment Address
®Cremation 21 Ouaker Road Queensbury, NY
Date Place Removed
Z El Removal and/or Held
and/or Address
N
Hold
0 Date Point of
ti ❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
:ii:. Permit Issued to M. B. Kilmer FUneral Home Registration Number
Name of Funeral Home D 1.0 7 8
Address
1 36 Main St. South GLens Falls, NY `. P`03
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
C
Ili
f` Permission is hereby granted to dispose of the human re ains described ove as indicated..
Date Issued ,21,)tab ct Registrar of Vital Statistics / 4 , 4,1_
(signature)
District Number 45.a Li Place 1/1(" ( 06 it- 6 /et,, /4/(
IE- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
gOw (
I� Date of Disposition ))a'1 III Place'of Disposition ,cue , ,j-
w
(address)
ILI
trl
CC (section) A (lot number) (grave number)
Name of Sexton or Per n incharge of Premises + "
Z (please print)
ILI
Signature Title Cil+= ,
(over)
DOH-1555 (02/2004)