Cowan, Robert NEW YORK STATE DEPARTMENT OF HEALTH � r2(D
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert D. Cowan Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 13, 2016 88 War or Dates 1945-1946
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death I Xi Natural Cause Accident n Homicide Suicide [1 Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Frances Bollinger
Address
161 Carey Rd. Queensbury,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5 6 0 i .5
II Burial Date Cemetery or Crematory
February 16, 2016 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
N ❑Transportation _ Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
�f Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
2 Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 21' 1 & /1 Registrar of Vital Statistics LA) cAm+�2.,
(signature)
District Number 5 Go f Place 6 5 11s I,)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
(�
Date of Disposition Z/111Ib Place of Disposition gmVe , Csw.4foelJ4'
(address)
co
re (section) (lot number) (grave number)
Q £
Name of Sexton or Person in Charge of Premises 4t,`a}�p�. .,,tlf-
Z (please print)
W
Signature Title lICAPIIUlt-
(over)
DOH-1555(02/2004)