Duffy, Robert 11
NEW YORK STATE DEPARTMENT OF HEALTH .}
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert J.Duffy Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/20/2018 75 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death 0 Natural Cause Accident 0 Homicide 0 Suicide El Undetermined El Pending
Circumstances Investigation_
Medical Certifier Name Title
Edit Masaba MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
'1,2, City, Town or Village Argyle 5750 33
00
❑Burial
Date Cemetery or Crematory
09/26/2018 Pine View Crematory
44❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
"7 Hold
p'
Date Point of
lio Transportation Shipment
i by Common Destination
Carrier
Q Disinterment
Date Cemetery Address
le
Li Reinterment
Date Cemetery Address
Permit Issued to Registration Number
-` Name of Funeral Home Alexander Baker Funeral Home 00037
Address
;. 3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above I
2 Address
CU
de
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/26/2018 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed)
(signature)
District Number 5750 Place Argyle, New York
Pr I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition q I j$iti Place of Disposition ?,al frioscvlOf i_.
(address)
0
(section) l rt(lot number) (grave number)
la
ci Name of Sexton or Person in Charge of Premises
3#,44
z (pie se print)
Signature G"✓� �►+ Title cameo
(over)
DOH-1555 (02/2004)