Thurling, Robert 4cy5-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Joseph Thurling Male
s Date of Death Age If Veteran of U.S. Armed Forces,
02/22/2011 16.*years War or Dates 1952-54
P . e of Death Hospital, Institution or
STo "S., X Glens Falls Street Address r,JPns Fags, N Y 12801
0. o Manner eat ZiNatural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending
L Circumstances Investigation
0.
in Medical Certifier Name Title
0 Suzanne Rayeski M D
Address
3767 Main Street Warrensburg, N Y 12885
iigii D th Certificate Filed District Number Register Number
Cit TovAJi X Glens_Falts 5R01 92
;::Burial Date Cemetery or Crematory
': s['Entombment 02/24/2011 Pine View Crematorium
Address
0 Vf.Ciemation Queenshiiry, NY 12804
Date Place Removed
Removal and/or Held
and/or Address
F= Hold
O.
0 Date Point of
Transportation Shipment
a by Common Destination
Carrier
El Disinterment Date_ Cemetery Address
•
iiiig ❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
im Name of Funeral Home Barton- Mc Dermott Funeral Home, Inc. 00134
Address
9 Pine Street Chestertown. N Y 12817
Name of Funeral Firm Making Disposition or to Whom
14, Remains are Shipped, If Other than Above
Address
W
III
Permission is hereby granted to dispose of the human remains descrJ4I4
bove as i ica
iin
Date Issued 02/24/2011 Registrar of Vital Statistics 4
(signature)
District Number c601 Place C;IPns Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t:LI Date of Disposition Z. 2 St;'i l Place of Disposition Y,„r�,tom If.wi..
(address)
LAC
i
CC (section) (lot numb r) (grave number)
Name of Sexton or P rson in Char of Premises �nst41.4- 3w.itif
Z +'/� (please print)
Signature . 4,lit Title C'NUh kioA
• (over)
DOH-1555 (02/2004)