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Patten, Robert
dl 301 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert Martin Patten Male Date of Death Age If Veteran of U.S.Armed Forces, 04/12/2018 97 Years War or Dates 1942-1945 Place of Death Hospital, Institution or 741 City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation 21 Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation WI rq Medical Certifier Name Title 21. Gwendolyn Morris-Dickinson PA :44qn, Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 183 ❑Burial Date Cemetery or Crematory 04/16/2018 Pine View Crematory .❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold cl Date Point of - ❑Transportation Shipment Z by Common Destination -' Carrier • ❑Disinterment Date Cemetery Address u ❑Renterment Date Cemetery Address fri, Permit Issued to Registration Number : Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom -g Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/16/2018 Registrar of Vital Statistics IRybertA Curtis(ECectronica1TySigned) �}y (signature) District Number 5601 Place Glens Falls, New York .11 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition w h 1i f ig Place of Disposition 'f,k O....,.- 49 (address) ral (section) number) (grave number) Name of Sexton or Person in Charge of Premises fi(lot r �� sit (pl ase print) Signature Title Ablimilkt (over) DOH-1555(02/2004)