Hurd, Robert NEW YORK STATE DEPARTMENT OF HEALTH Mi3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Clifford Hurd Male
iSi Date of Death Age If Veteran of U.S. Armed Forces,
1 2-1 -2 01 4 87 War or Dates NO
Place of Death 36 Catherine St. Hospital, Institution or
141 City, Town or Village Gansevoort Street Address
. Manner of Death 2 Natural Cause 0 Accident l Homicide El Suicide riUndetermined 0 Pending
t> Circumstances Investigation
to Medical Certifier Title
Get/Ha Abess MD
Address
3 Irongate Center Glens Falls, New York 12801
Death Certificate Filed Tn. of District Number i i n RegisterlN,uinber
City, Town or Village Northumberland `-� -1
>' ❑Burial Date Cemetery or Crematory
12-2-2014 Pine View Crematory
❑Entombment Address
[ Cremation 21 Quaker Road Queensbury, New York 12804
Date Place Removed
Z riRemoval and/or Held
and/or Address
Lt Hold
f
0 Date Point of
Transportation Shipment •
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to M. B. Kilmer Funeral Home Reghtr �n Number
Name of Funeral Home
Address
136 Main St. South Glens Falls, New York 12803
Name of Funeral Firm Making Disposition or to Whom
li Remains are Shipped, If Other than Above
', Address
I
LE/
i Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 1a Qa\n p\ki Registrar of Vital Statistics _o__)- p s___,-b V.A.
i) .-‘._
(signatu e)
ill District Number yb LAS Place ---TD, .c.„‘ c 1 V pY`t"f l 0/NI 6 9 N., -�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI
Date of Disposition 14-3"(+1 Place of Disposition 494w f N.,
2 (address)
W
CA
LC (section) (lot numb (grave number)
0 /� er
t Name of Sexton or Person in Charge of Premises C`r' ...NI-
A (please print)
g
Si nature /;t. Title at*ION
(over)
DOH-1555 (02/2004) •
I