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Hall, David Robert NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Robert Hall Male Date of Death Age If Veteran of U.S.Armed Forces, 12/06/2019 67 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc W p Manner of Death ©Natural Cause Accident Hoy iriJe F1 Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Philip Gara MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 103 Burial Date Cemetery,Crematory or Facility Name 1 211 6/2 0 1 9 Pine View Crematory Entombment Address X Cremation Queensbury Town,New York ❑Donation OZ ❑Removal Date Place Removed and/or and/or Held P Hold Address cn O d Date Point of (n ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address joReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/09/2019 Registrar of Vital Statistics Aimee Wakoney(ECectronicaCCy Signed (signature/ District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- Z Date of Disposition /�/�/—/ Place of Disposition f W (address) W N (section) (!at number/ (grave number/ aName of Sexton or Person in Char of Premises �Af1 1d r Z (please print) W Signature Title G DOH-1555(o7/18)p 1 of 2 a Public Health Law Sec. 4145(2b) 013152 Receipt Human remains of ` ` ` ' � `' `''`'"� M.. delivered on Er` , 20 f Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#