Kader, Robert IT-4/29V
NEW YORK STATE DEPARTMENT OF HEAL.rTH �Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert P. Kader male
Date of Death Age If Veteran of U.S. Armed Forces,
7/20/2014 73 War or Dates 1 960-1 963
Place of Death Hospital, Institution or
111 oily, Town orWillagx Lake Luzerne Street Address River Road
O Manner of Death❑ Natural Cause ElAccident ❑Homicide El Suicide El Undetermined ❑Pending
V Circumstances Investigation
W Medical Certifier NarmT� � �i
a William F. Orluck Co er
Address
Chestertown, NY
Death Certificate Filed District Number Register Number
C , Town c 1ill14 Lake Luzerne 5656
❑Burial Date Cemetery or Crematory
7/25/2014 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, NY
Date Place Removed
❑• Removal and/or Held
9. and/or Address
F.: Hold
o Date Point of
0❑Transportation Shipment
C by Common Destination
Carrier
❑Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
Address
24 Church St. , P.O. Box 500, Lake Luzerne, NY 12846
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Al
W
Permission is hereby granted to dispose of the hums r mains described a ve as indicated.
Date Issued � o _ Registrar of Vital Statisti s
(signature)
District Number ,.O 6-z, Place S jg Z te_ A YeZaie.eAi/
t- I certify that the remains of the decedent identified above were disposed of in accordant ith this permit on:
til Date of Disposition 702051 Place of Disposition 0,„e_ Vj t Q.„„„,„,„...
W (address)
Lf)
0 1 (section) (tgt �mber� (grave number)
p Name of Sexton o,A er . it Charge of Premises Y��/-Q, �!
(please rint)
la Signatur# J / Title
(over)
DOH-1555 (02/2004)