Denton, Robert NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert J. Denton Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 2,2011 52 War or Dates
Place of Death Hospital, Institution or
Z: City, Town or Village Warrensburg Street Address 4111 State Route 9
Manner of Death Natural Cause 1 Xl Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
u, Medical Certifier Name Title
a Paul Bachman
Address
H HN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660 /0
❑Burial Date Cemetery or Crematory
❑ August 5, 2011 Pine View Crematory
Entombment Address
❑x Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
1-- Hold
Ca
,,,;, Date Point of
; Transportation Shipment
? by Common Destination
Carrier
1 Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
, Name of Funeral Home Alexander-Baker Funeral Home 00035
_` ' Address
3809 Main Street,Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
! Remains are Shipped, If Other than Above
X] Address
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13-1 Permission is heri by ranted to dispose of the human - s • -scribed wove as indicated.
Date Issued G 4. /7 Registrar of Vital Statis . _ild%A I
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(signature)
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 41-S-I( Place of Disposition ,.,A 6Z✓ Cat ton,`
(address)
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0 (section) /1 (lot numb (grave number)
pName of Sexton or Person in Charg of Premises ` '�t, t� e" .S•%114-
Z < (please print)
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Signature Title G?tim •k1-04
(over)
DOH-1555 (02/2004)
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