Ryan, Robert ,; # -)yc
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Francis Ryan Female
Date of Death Age I If Veteran of U.S. Armed Forces,
9/9/2018 84 j War or Dates
i_ Place of Death 1 Hospital, Institution or
`Z City, Town or Village Queensbury Street Address 84 Burch Road
p Manner of Death n Natural Cause n Accident U Homicide n Suicide Undetermined n Pending
W Circumstances Investigation
W Medical Certifier Name Title
O _ Sawyer,MD
Address
161 Carey Road,Queensbury,NY
Death Certificate Filed Di ctNumber Register Number
City, Town or Village Queensbury '( I ?
❑Burial Date Cemetery or Crematory
❑Entombment September 11,2018 i Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ( I Removal and/or Held
and/or --- —_-- - ---
Address
H Hold
CO L
O Date Point of
WTransportation Shipment
p by Common Destination
CarrierE
Disinterment Date ! Cemetery Address
pi Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
E- Remains are Shipped, If Other than Above _
2 Address
rt
W—
a Permission is he eby granted to dispose of the human re ains described above s indicated.
Date Issue I.1 ��t x Registrar of Vital Statistics G� C A-L�
(signature)
District Numbf {2c--) Place (c)�.,_4-- 6--c Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
imDate of Disposition 9113111� Place of Disposition Z4.I{,v 1,..,;tcr'
Ill (address)
W
O (section) / (lot number) (grave number)
pName of Sexton or Person in Charge of Premises CAr., hsr` )CA411t
wZ (pl ase print)
Signature 4 2, Title ((ZE1g,
(over)
DOH-1555(02/2004)