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Pratt, Robert Henry It 108• NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Robert Henry Pratt Male Date of Death Age If Veteran of U.S.Armed Forces, 10/04/2020 78 Years War or Dates FI Place of Death Hospital,Institution or W City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center CI Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title CI Kathleen Steiger NP Address 3230 Church St,Valatie Village,New York 12184 Death Certificate Filed District Number Register Number City,Town or Village Valatie Village 1023 52 0 Burial Date Cemetery,Crematory or Facility Name 10/06/2020 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York 0 Donation Removal Date Place Removed - and/or and/or Held - Hold Address 0 d Date Point of N 11 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom f- Remains are Shipped,If Other than Above g Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2020 Registrar of Vital Statistics Barbara Ann Fischer(ECectronicallySigned) (signature) District Number 1023 Place Valatie Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- W Date of Disposition /O4b)i0 Place of Disposition 2 (address) W N a (section) Aloft number) it(grave number) d Name of Sexton or Person in Charge of Premi es4 n ��"^�f Z (pleasf print) W Signature Title co-mitive- DOH-1555(07/18)p 1 of 2 � t y Public Health Law Sec. 4145(2b) 0 a ,4 0 7 q Receipt Human remains of delivered on , 20' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# r,