Loading...
DeCelle, Robert $1336 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit 44 Name First Middle Last Sex i2obert F.DeCelle Mate .' Date of Death Age If Veteran of U.S. Armed Forces, 04/19/2018 92 Years War or Dates 1944-1946 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident 0 Homicide Ei Suicide El Undetermined 0 Pending 771 Circumstances Investigation 414, Medical Certifier Name Title '" William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 tt Death Certificate Filed District Number Register Number F. City,Town or Village Glens Falls 5601 _ 202 ❑Burial Date Cemetery or Crematory 04/20/2018 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed El Removal and/or Held and/or Address ; Hold Date Point of ., ❑Transportation Shipment by Common Destination Pe Carrier 1 El Disinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number 1 : Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 , Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom 4,2 Remains are Shipped, If Other than Above Address 6 FF°1$ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/20/2018 Registrar of Vital Statistics 9Z96ert A Curtis(Efectronicafly Signed) (signature) 'i District Number Place 5601 Glens Falls, New York i*ri ro ?; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Pi v.. , Date of Disposition p� �j p ��Z3I14 Place of Disposition '[��r.11..� ��` (address) Tr (section) /I/ (lot number)5. (grave number) 44 *- 1 Name of Sexton or Person in Charge of Pre ises RI A," 11' /J ( ease print) Signature Title (over) DOH-1555 (02/2004)