Loading...
Deyoe, Robert Edward NEWYORK STATE DEPARTMENT OF HEALTH Bureau of Vita Burial - Transit Permit l Records Name First Middle Last Sex Robert Edward Deyoe Male Date of Death Age 71feran of U.S.Armed Forces, 01/05/2020 69 Years r or Dates 1969-71 ZPlace of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending QW Circumstances Investigation Medical Certifier Name Title Gwendolyn Morris-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town orViUa a Glens Falls 5601 10 Burial Date Cemetery,Crematory or Facility Name 01/07/2020 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed P and/or and/or Held CO) Hold Address O CL W FITransportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment 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 IX W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/06/2020 Registrar of Vital Statistics Wp6ertAndrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, 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 $ 70 Place of Disposition W �- 2 (address) W CO) IX (section) (10 umber/ (grave number) 0 Name of Sexton or Person in Charge of Premises Z (please)*int)LL1 Signature l I� Title !p ID DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 013 914 Receipt Human remains of - ? j �� 1� 1 delivered on a ,�� , 20,_!: Pine View 6emetery —� Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# �— ---1� t`