Towne, Robert Clifford 03
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Clifford Towne Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/22/2019 81 Years War or Dates 1956-1959
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs —7Street Address Saratoga Hospital
to Manner of Death Undetermined Pending
0 Natural Cause Accident Homicide Suicide
u� Circumstances Investigation
U
W Medical Certifier Name Title
0 Numan Rashid MD
Address
211 Church St,Saratoga Springs, New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 624
7 Burial Date Cemetery,Crematory or Facility Name
11/25/2019 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or —7and/or Held
H N Hold Address
O
�. Date Point of
N Transportation Shipment
Q by Common
Carrier Destination
❑Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
cc
W
Q' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/25/2019 Registrar of Vital Statistics .7o n Pa-1!Fanck(Electronkad(Si-ned�
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
WDate of Disposition �u 2� Place of Disposition .,J ��..
Uj (address/
W
(0 (section) (lotnumber) (grave number)
Ir
G Name of Sexton or Person in Charge of remises r' t
(p ase ase print/
W Signature Title
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0131,S8
Receipt
Human remains of delivered on , 20
Pine View Cemetery Reyeisen6g the funeral home named on burial pe
Official Funeral Directors Reg.or License#