Straut Sr., Robert Alvin NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Alvin Straut Sr I Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/26/2020 82 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town --7Street Address Fort Hudson Nursing Center Inc
WW Manner of Death Undetermined Pendin
� Natural Cause �Accident �Homicide �Suicide � � g
C.) 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 25
❑Burial Date Cemetery,Crematory or Facility Name
03/30/2020 Pine View Crematory
Entombment Address
LCremation Queensbury Town, New York
Donation
OZRemoval Date Place Removed
and/or and/or Held
U) Hold Address
N
O
Na D Transportation 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 Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
Address
Q
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/30/2020 Registrar of Vital Statistics *J weMalron (E&tronica.T 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:
W Date of Disposition 3 Zb Place of Disposition -� ^ rua�
(address)
W
(section) (lot number) (grave number)
0 �(
GName of Sexton or Person in Charge of Premises ( a'^f
pl se print/Z
W Signature Title n
DOH-1555(07/18)p 1 of 2
¢ r
Public Health Law Sec. 4145(2b) 013486
#
Receipt
Human remains of delivered on , 20
`R
Pine View Cemetery'~ Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ;,