Howard, Robert NEW YORK STATE DEPARTMENT OF HEALTH , 4t2 Z- /
Vital Records Section Burial - Transit Permit
A
Name First Middle Last Sex
ROBERT JOHN HOWARD MALE
Date of Death Age If Veteran of U.S.Armed Forces,
04/01/2014 64 War or Dates
- Place of Death Hospital, Institution
6City,Town or Village City of Albany or Street Address ST. PETER'S HOSPITAL
' Manner of Death Natural
LU ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
r.) JOHN TAGGERT M.D.
Address
315 S. MANNING BLVD. ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 644
to Cemetery or Crematory
El Burial �02/2014 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z ❑ Removal and/or Held
and/or Address
I_ Hold
U)
aTransportation Date Point of
Cl); ❑ By Common Shipment
a Carrier Destination
El Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home MAYNARD D. BAKER FUNERAL HOME 01130
Address
11 LAFAYETTE ST. QUEENSBURY, NY 12804
- Name of Funeral Firm Making Disposition or to Whom
F
Remains are Shipped, If Other than Above
Address
Ce
IJd'
0- Permission is hereby granted to dispose of the human remains described
d'above as indicated.
Date 04/02/2014 Registrar of Vital Statistics '^'k"`''Q�' ( -¢ SN
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were 'sposed of in accordance with this permit on:
li Date of Disposition 44/ Place of Disposition f1'/v .. ' � il
/
LU (address)
W"
co
ce (section) of number) (grave number)
S�- k
W' Name of Sexton or P son in Charg of Premises G /�1 C-
(please print) C47-141,4401--
1Signature ^YLd Title /
(over)
DOH-1555 (02/2004)