Secor, Robert NEW YORK STATE DEPARTMENT OF HEALTH r
Vital Records Section Burial - Transit Permit
•
Name First Middle Last Sex
Robert ,T. Secor male
Date of Death Age If Veteran of U.S. Armed Forces,
02/05/2011 53 War or Dates n/a
-. Place of Death Hospital, Institution or
City, Town or Village Argyle - •-- Street Address 2 312 Coach Rd Lot 115
0 Manner of Death
Natural Cause El Accident D Homicide 0 Suicide �Undetermined ®Pending
114 Circumstances Investigation
W Medical Certifier Name Title
44 Max Cronnman MT)
Address
Prospect St . Granville , NY
Death Certificate Filed District Number Register Number
Kii
in City, Town or Village Argyle .,i r $O r `
0Burial Date Cemetery or Crematory /
2/9/2011 Pine View Crematory
• "'' ❑Entombment Address
. ? > Cremation 0ueensbury , NY
Date Place Removed
Removal and/or Held
1-1
and/or
Address
1
Hold
C Date Point of
Q TransC11. portation Shipment
EC by Common Destination
Carrier
:; Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and Denny Funeral Home
Address
94 Saratoga Ave South Glens Falls NY
Name of Funeral Firm Making Disposition or to Whom •
Remains are Shipped, If Other than Above
2 Address
Ili
P::'::
is her by granted to dispose of the human rema' described bove as. dicated.
69 ` Registrar of Vital Statistics L.
(signature)
District Number Place ()LLr1A / i d
I certifythat the remains of the decedent identified above w re disposed of in accordancewi permit on:
b p thisp rmi
,j
tit Date of Disposition f 1)2 o 11 Place of Disposition -PIN V ie_ Crr4.4 f of Ri&.
Z. (address)
Ili
(section) A (lot nuber) (grave number)
t Name of Sexton or Pe son in Charg of Premises L,i- 0wr Sonnttt
(please print)
Ili Signature Title G2c�f{}T01_
(over)
DOH-1555 (02/2004)