Feigenwinter, Robert NEW YORK STATE DEPARTMENT OF HEALTH
9„31 Pt 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Feigenwinter Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 5, 2014 72 War or Dates
t,;,. Place of Death Hospital, Institution or
Zs City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
Iti Q n Natural Cause ( �Accident n Homicide n Suicide ❑
Circumstances Investigation
tu Medical Certifier Name Title
0, Farhana Kamal,MD
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number RegisterNumber
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
April 7, 2014 Pine View Crematorium
❑Entombment Address
Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ• ❑Removal and/or Held
and/or Address
H Hold
N
Q Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
f Remains are Shipped, If Other than Above
Address
1
Ai Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Li I 1 ( HI Registrar of Vital Statistics W W.."."--
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance�^ with this permit on:
W Date of Disposition 4 MN Placeof Disposition rrg%) 47-clr.. -
2 (address)
W
CO
re (section) (lot number)g (grave number)
QName of Sexton or Person in Ch rge of Premises Aiv r
Z ( lease punt)
W 94 Si nature A- Title cruGev'oi'L
(over)
DOH-1555(02/2004)