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Young, Robert NEW YORK STATE DEPARTMENT OF HEALTH 2Z Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert C. Young Male r.;,:;, Date of Death Age If Veteran of U.S. Armed Forces, 'ji: April 1,2016 80 War or Dates National Guard : Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Ih X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Suzanne Blood MD .r▪: Address 161 Carey Road,Queensbury,NY 12804 Death Certificate Filed District Number Register Number • City, Town or Village 56O 7 75— ❑Burial Date Cemetery or Crematory ❑Entombment April 4, 2016 Pine View Crematorium Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ I I Removal and/or Held and/or Address E Hold N 0 Date Point of NI I Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number :;.; Name of Funeral Home Regan Denny Stafford Funeral Home 01443 ;;;r Address .;l;:, 53 Quaker Road, Queensbury, NY 12804 r:. Name of Funeral Firm Making Disposition or to Whom :; Remains are Shipped, If Other than Above S. Address .: Permission is hereby granted to dispose of the human remains described above as indicated. °: Date Issued `•/ '-1/ / 6 Registrar of Vital Statistics W QA� 5L'l Y\'. ALA/�.r c::;.-. (signet ) District Number S 6 c;i Place Cs ' \\5, W') I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ui Date of Disposition 41/5 I f, Place of Disposition ,Pr,,rol�;.v ei.�,,,,q ,,M., W (address) N 0 (section) (lot numb (grave number) p Name of Sexton or Person in Charge of Premises eme041 Z ( lease print) W al �IK Signature Title p1 (over) DOH-1555(02/2004)