Cording, Robert 41
NEW YORK STATE DEPARTMENT OF HEALTH :c
Vital Records Section Burial - Transit Permit
Name First < - Middle Last Sex
Robert ,,,_. K. Cording Male
Date of Death 'Age If Veteran of U.S. Armed Forces,
September 5,2011 85 War or Dates World War H
Place of Death Hospital, Institution or
Z. City, To vn or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W; Medical Certifier Name Title
Amy Hogan
Address
Two Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Regi umber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
El
Entombment September 12,2011 Pine View Crematory
Address
❑x Cremation Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
Hold
N
O Date Point of
coTransportation Shipment
p by Common Destination
Carrier
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
I— Remains are Shipped, If Other than Above
2 Address
w'
Ct. Permission is hereby granted to dispose of the human remains described ab ve s i 9c ted.
Date Issued Registrar of Vital Statistics ,//J ,,.� `LG
signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 11t5I it Place of Disposition Pi41/0J Ciw*(it_ .
W (address)
Cl)
(section) lot number) (grave number)
Q Name of Sexton or Person in Charge of remises r��� (y144
�Z (please pant)
Signature Title C Lee-
(over)
DOH-1555 (02/2004)