Robinson, Albert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
w x = Name First Middle Last Sex
Albert Lawrence Robinson Male
c' Date of Death Age If Veteran of U.S. Armed Forces,
® July 5,2014 87 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
la
Manner of Death X Natural Cause n Accident 7 Homicide Suicide Undetermined Pending
1,14 Circumstances Investigation
tik Medical Certifier Name Title
a Dr.William Borgos
$..., Address
_._ 5 14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Re r Number
G City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
July 11,2014 Pine View Crematory
❑Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
- Hold ,
N
O Date Point of
uTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
51 Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
x-• r. Address
• 1 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
5 Address
al:
WI
: Permission is hereby granted to dispose of the human remains described bove as indic ed.
4,1
Date Issued Q / JReistrar of Vital Statistics 4
g<§, (signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above w e disposed of in accordance with this permit on:
Z
Date of Disposition 1-i(0`(u Place of Disposition ,Ati,it.,) Crr.. GP,,.
W (address)
Cl)
0 O (section) I
,(lot nuer) (grave number)
p, Name of Sexton or Person in Charge of Premises 51
Z lease print)
W
Signature A- L- Title orkeiry
(over)
DOH-1555 (02/2004)