Loading...
Hitchcock, Robert NEW YORK STATE DEPARTMENT OF HEALTH ; 1 # 577 _Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert Deforst Hitchcock Male Date of Death Age If Veteran of U.S. Armed Forces, ,; August 6, 2014 74 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Natural Cause 0 Accident D Homicide 0 Suicide DUndetermined ri Pending zr Circumstances Investigation Medical Certifier Name Title Address Death Certificate Filed District Number /©� Register Number 34, City, Town or Village Glens Falls (� 3 c/ Date Cemetery or Crematory ❑Burial August 8, 2014 Pine View 0 Entombment Address Y`;®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held aHoldnd/or Address Date Point of 0. ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number `' Name of Funeral Home M. B. Kilmer Funeral Home 01077 '.°X.1 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ` .- Permission is hereby granted to dispose of the human remains described above aspindicated. Date Issued / ?/l dl Registrar of Vital Statistics LAJ Ck.A4-v-,..32, UQA.1%-C (signature) District Number 60 ) Place C ,l.S \\S P y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t : Date of Disposition 08/08/2014 Place of Disposition Quaker Road Queensbury,NY 12804 (address) ', (section) �4 (lot number) r (grave number) ;_; Name of Sexton or Pers n in Charge of Premises aAsl JIN+/14� (phase print) Signature L's-. -0----- Title C1 "mr}rak- (over) DOH-1555 (02/2004)