Reilly, RobertNEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial -Transit Permit
Name First Middle Last
Sex
Robert J Reilly
Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
10/20/2019
84 Years
War or Dates
Place of Death Hospital, Institution or
Z
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death NLaiaturalCause Accident Homicide Suicide Undetermined Pending
1p
Circumstances Investigation
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Medical Certifier Name Title
iD
Heather Madigan DO
Address
211 Church St, Saratoga Springs, New York 12866
Death Certificate Filed
District Number
Register Number
City, Town or Village Saratoga Springs
4501
551
Burial
Date �, Cemetery, Crematory or Facility Name
Entombment
10/25/2019 Pineview Crematory
Address
Cremation
Queensbury Town, New York
Donation
Date
Place Removed
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❑Removal
and/or
and/or Held
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Hold
Address
N
O
LL
Date
Point of
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❑ Transportation
by Common
Shipment
Carrier
Destination
Disinterment
Date
Cemetery Address
Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Densmore Funeral Home Inc
00448
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
I—
Remains are Shipped, If Other than Above
Address
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a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/22/2019 Registrar of Vital Statistics John Paul Franck (Electronically Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Date of Disposition (p� 1$ � �cj Place of Disposition 'lt ut+v—
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U
(address)
C
(section) Pot number) (grave number)
SA
Name of Sexton or Person in Charge of Premises 1 �� a.A4b
n (Pleke print)
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fW
,
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Signature (�/,✓/, Title `
DOH-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b)
0 13 Oe"- 7
Receipt
Human remains of —< delivered on
Pine View Cemetery
Official
, 20
Repreg'e-nting the funeral home named on burial permit
Funeral Directors Reg. or License # / � '- I ' '