Linendoll, Robert I! 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
-4' Name First Middle • Last Sex
Robert Lee Linendoll Male
Date of Death Age If Veteran of U.S. Armed Forces,
01 12/11/2018 82 Years War or Dates
• Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause ❑Accident 0 Homicide 0 Suicide ❑Undetermined ❑Pending
IiiCircumstances Investigation
Medical Certifier Name Title
Scott Biasetti MD
Address
. 100 Park St,Glens Falls,New York 12801
''' Death Certificate Filed District Number Register Number
• City, Town or Village Glens Falls 5601 584
Burial Date Cemetery or Crematory
12/15/2018 Pine View Cemetery
['Entombment Address
��,a
w Cremation❑ Queensbury Town, New York
': Date Place Removed
• ❑Removal and/or Held
17 I and/or Address
Hold
Date Point of
„ 11 i Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
, Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
tRemains are Shipped, If Other than Above
Address
i1
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/12/2018 Registrar of Vital Statistics Robert A Curtis(Ekctronicalty Signed)
(signature)
District Number 5601 Place Glens Falls, New York
III• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t Date of Disposition 1 2/1 5/1 &lace of Disposition Pine View Cemetery Queensbury
(address)
Horicon 14-B 1
(section) (lot number) (grave number)
Name of xton or Person i Charge of P emises Connie L_ Goedert-
(please print)
Signature Title Cemetery Superintendent
(over)
DOH-1555 (02/2004)