Sinnott, Robert - „ n3
NEW YORK STATE DEPARTMENT OF HEALTH- / �,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert W. Sinnott Male
z Date of Death Age If Veteran of U.S. Armed Forces,
March 12, 2014 81 War or Dates
8'..?, Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death n Natural Cause El Accident Ei Homicide n Suicide ❑Undetermined Pending
141 Circumstances Investigation
Medic I Certifier �-�va Title
ct 1� . N, ��LC4. prn
&leS dre s,` ^nL ) -
'', Death Certificate Filed i a District Number Register Number
City, Town or Village Glens Falls,NY 5601 i 2 1
❑Burial Date Cemetery or Crematory
❑Entombment March 17, 2014 Pine View Crematorium
Address
I1 Cremation 21 Quaker Road,Queensbury,NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
H Hold
N
O Date Point of
Nn Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
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
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued /i L/ Pig Registrar of Vital Statistics t.l.3Ct�,-\2 —"V -
(signature)
'- District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition3—/7-/V Place of Disposition R A./4 Vr/L✓ C� ljr( (
2 (address)
W
Cl)
a' (section) (IQ�umber)11 (grave number)
QName of Sexton, r P rson i arge of Premises Sc `�--0,� )(V\
Z (please print)
W
Signature Title C1AAA A J o
7 (over)
DOH-1555(02/2004)