Loading...
Mulgrew, Robert NEW YORK STATE DEPARTMENT OF HEALTH ' it J J Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert Thomas Mulgrew Male Date of Death Age If Veteran of U.S. Armed Forces, Au ust 2, 2016 59 War orpates Z Plac f D ath , Hospital, Institution or City ty Tow or Village Bolton Landing ' Street Address 26 Ledgeview Lane 0 Mann of Death ❑ Natural Cause X❑ Accident El Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title C Michael Sikirica MD, Address 50 Broad Street Waterford, NY 12188 Death ificate Filed L District Number Register Ny tuber City own .)r Village o( r d rm - 6/4 57) V ❑Burial Date Cemetery or Crematory August 5, 2016 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ,n Removal and/or Held • LJ and/or Address E Hold CO Date Point of eL ❑Transportation Shipment 0) by Common Destination CS Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I_ Remains are Shipped, If Other than Above MAddress W a' Permission is hereby granted to dispose of the human remains described a ove Mdicat d. Date Issued O SS- 0 5-zoy(,Registrar of Vital Statistics (signature) District Number 5(.o5 0 Place 'E..'t-Q LI I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 08/05/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2- (address) W CO r (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pr raises /i15t - `.,.h z ( lease print) W, Signature Title IMPS 9 (over) DOH-1555 (02/2004)