Truax, Robert NEW YORK STATE DEPARTMENT OF HEALTH - R II 123
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
-. Robert Morton Truax Male
Date of Death Age If Veteran of U.S. Armed Forces,
--. March 10, 2015 81 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address 2312 Coach Road
Manner of Death1=1 Natural Cause ❑ Accident 0 Homicide 0 Suicide ❑ Undetermined ri 1-1 Pending
CircumstancesInvestigation
Medical Certifier Name Title
Patricia Auer,
Address
316 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Argyle 575% '-)
❑Burial Date Cemetery or Crematory
March 12, 2015 Pine View Crematory
❑Entombment
v . Address
®Cremation Quaker Road Queensbury,NY 12804
10
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
nTransportation Shipment
by Common Destination
Carrier
I
❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
AIV
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
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 remains described above as indicated.
'CA!. Date Issued 3) 11 is Registrar of Vital Statistics aceit ktyl cife.,,,f-
t ,
(signature)
gi District Number 5 75 0 Place GA1 t'(Q K)ka
t;vY
'
; -"s; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/12/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises I
(p f ease print)
Signature Title 6214-0t
(over)
DOH-1555 (02/2004)