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Doyle, Robert NEW YORK STATE DEPARTMENT OF HEALTH ,. a,, 15 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert Thomas Doyle Male Date of Death Age If Veteran of U.S. Armed Forces, June 16, 2011 58 War or Dates Place of Death Hospital,Institution or City, Town or Village Queensbury Street Address 8 Belle Avenue Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Paul Bachman, M.D. Address 3767 Main Street Warrensburg, NY 12885 Death Certificate Filed District Number Re ister Number City, Town or Village � � '') 0 Burial Date Cemetery or Crematory June 20, 2011 Pine View Crematorium ['Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Removal Date Place Removed and/or ) and/or Held Hold Address Date Point of 0 Transportation Shipment byCommon Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 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 � Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human re s described abov as 'ndicated. Date Issued 100 fc�J j 1 Registrar of Vital Statistics rr i G , ( .--r-N (signature) } --------- District Numbcj(oc Place ( Cj --, O Cat-AJLext,.. --.,--‘....--, I certify that the remains of the decedent identified above were disposed of in acco danc with this permit on: Date of Disposition c/21)ii Place of Disposition Pivwv (,crr,,,toe)4m, (address) (section) a (Lot number) _ (grave number) Name of Sexton or Person in Charge f Premises Irt �r e�►rtbt (pie se print) Signature dirk_. Title C1ZI Mvk1Q(L (over) DOH-1555 (02/2004)