Crawford, Robert Olt
NEW YORK STATE DEPARTMENT ' HEALTH Burial Transit Permit
Vital Records Section
>! Name First Middle Last Sex
Robert Dale Crawford Male
Date of Death Age If Veteran of U.S. Armed Forces,
06 / 12 / 2018 81 War or Dates 1954-1956
1 Place of Death Hospital, Institution or
City, Town or Village Moreau Street Address 169 Burt Road
Iiii0 Manner of Death®Natural Cause 0 Accident 0 Homicide D Suicide ❑Undetermined Pending
W. Circumstances Investigation
ut Medical Certifier Name Title
A Numan Rashid MD
Address
19 West Ave Ste 101 Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City,Town or Village Moreau ( - T7 �.
€?: BUrlal Date Cemetery or Crematory
06 / 12 / 2018 Pine View Crematory
nEntombment Address
fC'l p Cremation Queensbury, NY
Date Place Removed
❑EFIRemoval and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
E Disinterment Date Cemetery Address
Q Reinterment Date ' Cemetery Address
Ni Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. , NY 12866
.ii> Name of Funeral Firm Making Disposition or to Whom
NRemains are Shipped, If Other than Above
Address
Ili
Permission is hereby ranted to dispose of the human remains cribed v :a indicated.
Date Issued 07 do/B Registrar of Vital Statistics )(6( #1 'i'7
s' District Number ((goa- Place Moreau , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IiLi Date of Disposition 42 1 iy i14 Place of Disposition ,ti y g-vi
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(section) llot
number)` (grave number)
Name of Sexton or Person ip Charge of Premises Y`�
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i, Signature w Title ` '4rdv
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(over)
DOH-1555 (02/2004)