Steves Sr., Robert NEW YORK STATE DEPARTMENT OF HEALTH t g
Vital Records Section Burial - Transit r ermit
Name First Middle Last Sex
Robert G. Steves Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
1. June 11, 2017 et War or Dates
Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
a Manner of Death 0 Natural Cause 0 Accident 0 Homicide iiii Suicide Q Undetermined El Pending
W Circumstances Investigation
0 Medical Certifier Name Title
ill Dr. Dean Reali, M.D. Dr.
a Address
3767 Main Street, Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls c 33�u/ D?(C�
❑Burial Date Cemetery or Crematory
June 13, 2017 Pineview Crematorium
❑Entombment Address
• EI Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 0 Removal and/or Held
- and/or Address
i" Hold
0 Date Point of
0 E Transportation Shipment
L by Common Destination
Carrier
- Date Cemetery Address
Q Li Disinterment
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
F= Name of Funeral Firm Making Disposition or to Whom
te
!r Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.r
Date Issued 6 I 1 3 l /? Registrar of Vital Statistics L3 CAJqpc\Q w
(signature)
District Number 5 I0 0 1 Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
W Date of Disposition 06/13/2017 Place of Disposition Pineview Crematorium
2 (address)
w
W
(section) II(Io number) c (grave number)
Name of Sexton or Person in Charge of Premises Chry t4 A l
W (plea a print)
iff,
Signature b� , Title Cit£Mt1To{Z
(over)
DOH-1555 (02/2004)