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Robson, Ronald t 1 4/ —70 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Ronald W. Robson Male Date of Death Age If Veteran of U.S. Armed Forces, January 25,2014 69 War or Dates .. Place of Death Hospital, Institution or Z City, Town or Village Lake George 1 Street Address 61 Mohican Street p Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Ci Suzanne Bergin Address 3767 Main Street,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Lake George 5620 6 2© / ❑Burial Date Cemetery or Crematory ❑Entombment January 27,2014 Pine View Crematory Address 1 Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed ZZ Removal and/or Held and/or Address 1' Hold N 0 Date i Point of N Transportation 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 i— Remains are Shipped, If Other than Above S Address fY E1. Permission is hereby granted to dispose of the human rem 'us described a ov s indicated. Date Issued O11d.7/o2O/41 Registrar of Vital Statistics (signature) District Number 5620 Place Lake George I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Disposition /� III Disposition "eV 1 L t4".4.X1L-/ g Date of Place of r.J W (address) co 0 (section) tot nu ber) (grave number) p Name of Sexton or Per n in Charge of Premises ,, Stv � Z (plea print) W Signature Title C etr1A-ide (over) DOH-1555 (02/2004)