Foley, Robert NEW YORK STATE DEPARTMENT OF HEALTH (`')
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert J. Foley Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 11,2015 82 War or Dates
Place of Death Hospital, Institution or
Z; City, Town or Village Minerva Street Address 135 John Brannon Road
p Manner of Death X Natural Cause j Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
u Medical Certifier Name Title
Dr.John Sawyer,MD
Address
14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Regist Number
City, Town or Village 1557
❑Burial Date Cemetery or Crematory
❑Entombment September 14, 2015 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
v)
0 Date Point of
NTransportation Shipment
a 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 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
W'
Permission is hereby granted to dispose of the huma mains described above as indicated.
Date Issued q-15 l 5 Registrar of Vital Statistics
(signature)
District Number 1557 Place Minerva
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
L
� Date of Disposition ��iW�s Place of Disposition �,� Q��„r
W (address)
V)
(section) lot nu er) (grave number)
Q Name of Sexton or Person in Charge of Premises11, mar
Z (please print)
Signature Title
(over)
DOH-1555 (02/2004)