Alden, Robert Z
NEW YORK SATE DEPARTMENT OF HEALTH 'Vital Records Section Burial - Transit Permit
. Name First Middle Last Sex
Robert E. Alden Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 29,2015 86 War or Dates
,;. Place of Death Hospital, Institution or
Z City, Town or Village Moreau Street Address 8 Jon Kay Road
4,11
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W= Circumstances Investigation
Medical Certifier Name Title
a; T. Slingerland
Address
== GFH,Glens Falls,NY 12801
s_ Death Certificate Filed District Number Register Number
- City, Town or Village T/O Moreau 4562 (o O
❑Burial Date - Cemetery or Crematory
December 34,2015 Pine View Crematory
❑Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
E' Hold
Cl)
0 Date Point of
NI I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
;. Permit Issued to Registration Number
a. Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
Address
e
W.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued /o2��3ii.?0/ �- Registrar of Vital Statistics /;(2 J—L
(signature)
District Number 4562 Place 76,1(2 Q f M0 ,Cie a -'-.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /-5--/4 Place of Disposition t /77 e iJ ejj CiU14a4,
E (addrg�
W
co
ct (section) ,,(lot number) (grave number)
pName of Sexton or Pe son in Charge of Premises Jt,1/4. 1,G-✓k. &a,., -he
Z (please print)
W ---
Signature Title Gtrrr�o/
(over)
DOH-1555 (02/2004)