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Russ, Robert NEW YORK STATE DEPARTMENT OF HEALTH%r ""t l gla Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert Howard Russ Male Date of Death Age If Veteran of U.S. Armed Forces, June 15, 2018 51 War or Dates ▪ Place of Death Hospital, Institution or W City, Town or Village Argyle Street Address 3026 Aarons Way Manner of Death Natural Cause 0 Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending U Circumstances Investigation W Medical Certifier Name Title Max Crossman, M.D. Dr. Address 65 Poultney Steet Whitehall, NY 12887 Death Certificate Filed District Number r� Register Number City, Town or Village Argyle / 50 a v ❑Burial Date Cemetery or Crematory June 18, 2018 Pine View Crematory 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 ' Date Ffa e eltoved - - z ❑ Removal and/or Held and/or Address p Hold CA Date Point of • ❑Transportation Shipment by Common Destination a Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 31 Address Cr III C Permission is hereby granted to dispose of the human re 'ns described above as indicated. Date Issued (pI f *aoil Registrar of Vital Statistics 11`k,A,r,,,, //�� (signature) ,4► District Number 57S6 Place ' y /( Al I--` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 06/18/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) Ut CO i! (section) 1.(lot number) (grave number) O' Name of Sexton or Person in Char of Premises �A^� ��^^* ()Tease print) U t Signature Title tioni'►rICOIL (over) DOH-1555 (02/2004)