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Taft, RobertN EW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records L F Burial - Transit Permit Name First Middle Last Sex Robert VanNess Taft Male Date of Death Age If Veteran of U.S. Armed Forces, 09/28/2019 81 Years WarorDates 1963-67 Place of Death Hospital, Institution or WCity, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined ❑ Pending p Circumstances Investigation W Medical Certifier Name Title C3 Edit Masaba MD Address 4573 State Route 40, Argyle Town, New York 12809 Death Certificate Filed District Number Register Number City, Town or Village Argyle 5750 39 Burial Date Cemetery, Crematory or Facility Name 09/30/2019 Pine View Crematory Entombment Address FRICremation Queensbury Town, New York Donation Removal Date Place Removed 0 and/or and/or Held H Hold Address N O a Date Point of CO) p ❑ Transportation 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 Horne- South Glens Falls 01078 Address 136 Main St, S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition orto Whom I—. Remains are Shipped, If Otherthan Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/30/2019 Registrar of Vital Statistics Shelley Mckernon (Electronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— WDate of Disposition loll IIIPlace of Disposition 2 (address) W (1) (section/ (tot number) (grave number) f Name of Sexton or Person in Charge of Pre 'ses t' Z /p ase print/ taJ Signature Title DO H-1555 (07/18) p 1 of 2 Public Health Law Sec. 4145(2b) 012568 Receipt delivered on Human remains of NI 20 Pine View Cemetery Representing the funeral home named 7bup t n, al Official Funeral Directors Reg. or License #-- T-f