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Stickney, Robert Hyde N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Hyde Stickney Male Date of Death Age If Veteran of U.S.Armed Forces, 11/09/2019 84 Years War or Dates 1954-1956 F Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing W `p Manner of Death ©Natural Cause Accident ❑Homicide Suicide Undetermined Pending V Circumstances Investigation Gl Medical Certifier Name Title Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 88 Burial Date Cemetery,Crematory or Facility Name 11/12/2019 Pine View Crematorium Entombment Address lCremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held H Hold Address fh O a- Date Point of Cl) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom _ Remains are Shipped,If Otherthan Above g Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/12/2019 Registrar of Vital Statistics YennyGind'a 9KarteCCe(ECectronicalCySiyned) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 11113111 Place of Disposition ,, ,�+ n tv W /address/ W N X /section/ /lotnumbe (grave number/ Q Name of Sexton or Person in Charge of P emises z Z /p ase print/ W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013075 Receipt + A � delivered on � , 20_��Human remains of �_� "" Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#