Marinelli, Robert NEW YORK STATE DEPARTMENT OF HEALTH t A. #4 3 i
Vital Records Section Burial - Transit Permit
( ' Name First Middle Last Sex
Robert Frank Marinelli Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 2,2017 88 War or Dates Korean
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 44 Willobrook Rd.,Apt. 124
Manner of Death X Natural Cause Accident � I Homicide Suicide Undetermined Pending
Circumstances Investigation
u Medical Certifier Name Title
CI Paul Bachman
Address
H ifiN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village S(, rj 1 `Z q-
❑Burial Date Cemetery or Crematory
Entombment June 6,2017 Pine View Crematory
El Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
H Hold
co
O Date Point of
y Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ur
Xti;
Permission is hereby granted to dispose of the human re de o dic ted.
Date Issued Ct-G-an 11 Registrar of Vital Statistics V U-A-0 J(ls
(signature)
District Number KA.ps 1 Place 1 19 �. �n 1 _�
I certify that the remains of the decedent identified above re disposed of in accor nce . h this permit on:
Z Disposition (911 /� p �[7� ,�Ij
W Date of Place of Disposition 'I«zVt hiv.4110rr�
W (address)
co
ec (section) //b�lot number) (grave number)
Q Name of Sexton or Person in Charg of Premises /1,4-tri,�/ ibt
Z (plealse print)
W Signature Li Title 1411t-
(over)
DOH-1555 (02/2004)