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Tourge, Robert J.
4 3 -� NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert J.Tourge I Male Date of Death Age If Veteran of U.S.Armed Forces, 01/10/2020 71 Years WarorDates 1968-1974 Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 23 Burial Date Cemetery,Crematory or Facility Name 01/13/2020 Pine View Crematory Entombment Address ICremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held _ i-N Hold Address O a Date Point of N FiTransportation Shipment p 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 f.. Remains are Shipped,If Other than Above Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/13/2020 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: H � W Date of Disposition f IS 170 Place of Disposition - tv LU (address) W N (section) (lot number) (grave number) a Name of Sexton or Person in Charge of Premiss tt `^�' (p/e a grin LU tT- Signature Title AMA ' DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 -3 2 3 1 Receipt Human remains of delivered on , 20 Pine View Cemetery RepreWentingithe funeral home named on burial permit Official Funeral Directors Reg.or License# %'