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Rabe, Robert tit NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit C�u�,,,y: I Name First Middle , Last Sex Robert Rabe Male Date of Death Age If Veteran gLU1t. Armed Forces, 1 9 4 5-1 9 4 6 May 2, 2018 91 War or Dates 1-- Place of Death Hospital, Institution or W' City, Town or Village Moreau Street Address 5 Laurel Road W. Manner of Death X❑ Natural Cause l i Accident I I Homicide ❑ Suicide n Undetermined ❑ Pending Circumstances Investigation 1.11r Medical Certifier Name Title CI Glen Anderson PA Address 161 Carey Road, Queensbury, NY 12804 Death Certificate Filed District Number Register Number City, Town or Village 1/6(e4-� (1 ❑Burial Date Cemetery or Crematory May 3, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed 7riRemoval and/or Held . and/or Address p,„ Hold CO_, Date Point of k.n Transportation Shipment �� by Common Destination Q Carrier I I Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 ,' Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped, If Other than Above 2. Address CC 111 `; Permission is hereby granted to dispose of the human_remains descr"•• • �•ove s indicated. Date Issued, 13 /X Registrar of Vital Statistics 7 �. , f (signature) District Number g5()- Place 3. / 6-'/z/c/siet. `/ a'( /J`0 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W_ Date of Disposition 05/03/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) UJ 01''"! r (section) /� (lot number (grave number) 0 0. Name of Sexton or Person in Charge f Premises G �e �iw►•if please print) 11I Signature ^tt Title (t*' 2 (over) DOH-1555 (02/2004)