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Wilkins, Robert E.
r-g) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert E.Wilkins Male Date of Death Age If Veteran of U.S.Armed Forces, 03/27/2020 71 Years War or Dates I— Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide El Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Stephen Perazzelli MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 142 ❑Burial Date Cemetery,Crematory or Facility Name 03/28/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ❑Donation 0z Removal Date Place Removed and/or and/or Held ~N Hold Address O IL Date Point of (1) Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address IX W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2020 Registrar of vital statistics Robert Andrew 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 3 IN (ZZ Place of Disposition ZL W (address) W N (section) (tot number) (grave number) GName of Sexton or Person in Charge of Pr miles Z (ple e print) W Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ,f Receipt Human remains of delivered on , 20 i Pme View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# g