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Rieger, Richard r - V NEW YORK STATE DEPARTMENT OF HEALTH Zg Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard William Rieger Male Date of Death Age , If Vetbran of U.S. Armed Forces, 07/09/2017 81 War or Dates }- Place of Death Hospital, Institution or Glens Falls Glens Falls Hospital Z City, Town or Village Street Address p Ici li of Death Undetermined Pending Natural Cause �Accident �Homicide �Suicide la � � Circumstances Investigation ILI Medical Certifier Name Title g Christopher Hoy MD Address 161 Carey Rd Queensbury, NY Death Certificate Filed Glens Falls District Number Register Number City, Town or Village 5 (J D/ 3 —7 li; ❑Burial Date 07/10/2017 Cemetery or Crematory Pine View Crematory ❑Entombment Address 21 Quaker Rd Queensbury NY ;;: ©Cremation Date Place Removed is❑Removal and/or Held 2 and/or Address F_- Hold to 0 Date Point of 95❑Transportation Shipment 0 by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to M.B. Kilmer Funeral Home Registration Number <> Name of Funeral Home 01078 Address 136 Main St South Glens Falls, NY 12803 Name of Funeral Firm Making Disposition or to Whom 1_- Remains are Shipped, If Other than Above ,2 Address LC Ili Permission is hereby granted to dispose of the human remains described above as i 'ca ed. Date Issued -7 I ( di-7 Registrar of Vital Statistics )C.LA.. y) Q � � �,. 11 (signature District Number 5 6 0 I Place 6 ("'�S` Fo, ( l 5 to y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i p ?113 Dispositione�.e `t^* najo("-.' lJf� Date of Disposition 3 fZ Place of �./ 2 (address) ili CC (section) (lot number) (grave number) 0. CI Name of Sexton or Person in Charge of Premises �1 cu r 3i.,,ALit Z (ple se print) iii 4, Signature e ON Title f )liPt (over) DOH-1555 (02/2004)