Gatland, Robert ♦ ...Mt 'M NEW YORK STATE DEPARTMENT OF HEALTH t,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert A. Gatland Male
Date of Death Age If Veteran of U.S. Armed Forces,
08 / 24 / 2017 77 War or Dates Korean
i . Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address
Glens Falls Hospital
wManner of Death rE Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined �Pending
Circumstances Investigation
itl Medical Certifier Name Title
q Carl Sgambati MD
Address
3050 NY-50, Saratoga Springs, NY 12866
Death Certificate Filed District Number •u0 1 Register,Nu Number
City, Town or Village Glens Falls `i I
°Burial Date Cemetery or Crematory
08 / 28 / 2017 Pine View Crematory
iiiil DEntombment Address
Cremation Queensbury, NY
"'` Date Place Removed
Z ri Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
C by Common Destination
Carrier
Ri
Q Disinterment Date Cemetery Address
Og
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
iiiiiiiii! Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z Address
ir
Cr Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued g/2/ 20 / -Registrar of Vital Statistics tAkAAdrY1 kii.AZ,
(signatu )
l( District Number 5 60 i Place Glens Falls , New York
,<, . I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z o 1��
10 Date of Disposition �)3c hi Place of Disposition T 4,11.-i ‘ernwlorNJ
(address)
111
tr (section) otnumber) c (grave number)
,ci Name of Sexton o.r Person in Charge of P emises RfAftb- _J .-Aitt
z
(plea a print) •
Signature !�L tr- Tit►e 112iAilit
(over)
DOH-1555 (02/2004)