Tobias, George -v.
1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
_j{ Name First
Middle Last Sex
,e.-4 George Tobias Male
;:.r?. Date of Death Age If Veteran of U.S. Armed Forces,
October 22, 2016 85 War or Dates NA _
r;, Place of Death Hospital, Institution or
. City, Town or Village Town of Queensbury Street Address 151 Aviation Rd. Queensbury, NY
,.r Manner of Death X Natural Cause n Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
S 9
Medical Certifier Name Title
Patricia Auer Nurse Practioner
? , Address
n 316 Care Rd. ueensbu NY 12804
,' Death Certificate Filed Di5rict Number Re ister,,Dlumber
City,11 Town or Village ( � ,SS
9 Town of Queensbury, NY
❑x Burial Date Cemetery or Crematory
October 26, 2016 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road Queensbury, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
Cl)
O Date Point of
NE Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
'z - Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
ai Address
D. 407 Bay Road, Queensbury, NY 12804
i f Name of Funeral Firm Making Disposition or to Whom
f'E Remains are Shipped, If Other than Above
Address
'J Permission is hereby granted to dispose of the human remains described above as indicated. 4
MI Date Issued\ \J-L-1 c9-0 fir, Registrar of Vital Statistics Q''—_ �/t /l
(signature)
-----,
iiaa District Number e S`-1 Place ) 0 C) -$ C L� 4-
F I certify that the remains of the decedent identified above were disposed of in accord t ice wit this permit on:
Z
'a Date of Disposition 1 0/26/1 6 Place of Disposition Pine View Cemetery, Queensbury,NY
2 (address)
AU
U) Horicon 12I 1
(section) (lot number) (grave number)
p Name of Se n or Person in Charge of Premi Connie L. Goedert
Z (please print)
W Signature o t �t L- e- �1111S,s4. • Title Cemetery Superintendent
(over)
DOH-1555(02/2004)
LAWERENCE/TOBIAS 04!)
Owner
Margit Lawerence; Imre Tobias
Address Plot
151 Aviation Road, Queensbury, NY 12804 Horicon
Phone # Lot #
(518) 791 -2345; (51 8)409-461 7 121
Deed # Date
3975 10/94/11
Cost Foundation Y - N
1200
Location
Bounded on the North by Vacant, South by Bishop
East by Howk and West by Path
Remarks
Record of Interments
1 George Tobias 10/26/16 FB 6
2 L. coaa. �3 7
m Q — \ ,�►� a o a 3
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3 8
4 9
5 10
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TOBIAS
NAME George Tobias Age: 85
Lot Owner: Margit Lawerence; Imre Tobias
Lot# 12I, Horicon Grave# 1
Case: Concrete
Died: 1 0/2 2/2 01 6 Interred: 1 0/2 6/1 6
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View