Carpenter Jr, Robert 07/10/2014 08:57 518377344E LIGHTS FUNERAL HOME PAGE 01/01
NEW YORK STATE DEPARTMENT OF HEALTH 3 it
M.'
Vital Records Section Burial - Transit Permit
:s Name First Robert T_ Middle Edward Last arpenter Jr ' Sex Male
Date of Death Age f Veteran of U.S. Armed Forces,
07/07/2014 67 year War or Dates no
Place of Death ! Hospital, Institution or
City, Tow4PCi1XX Schenectady 1 Street Address 13 State St, Schenectady
Lai Manner ofDeath❑Natural Cause 1 i Accident n Homicide Suicide Undetermined f'„ ending
Circumstances Investigation
to Medical Certifier Name Title
I N Balasubramaniam Medical Examiner
ki
Addr9l1 Nott St, Schenectady, N Y 12308
Death Ce cate Filed _ District Number ' Register Number
Cit rLTowN 'iNWx Schenectady y 4601 594
4 OBurial Date Cemetery or Crematory
07/10/2014 Pineview Crematorium
zir ❑ ombment Address
jl, cremation Queensbury, N Y
i!f.' Date Place Removed
u Removal and/or Held
and/or Address - --
Hold
CB
fa - — bate Point of
itli
till Transportation _ Shipment
ci by Common Destination
Carrier
?. ❑Disinterment Date Cemetery Address
f —
Date Cemetery Address
❑Reinterment
Permit issued to Regan & Denny Funeral Service Registration Number
`' Name of Funeral Home01443
I'' Address 53 Quaker Rd, Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above -
Address
i1
I
>1L Permission is hereby granted to dispose of the human remains. es ribe �Jabo as 'cated.
Ul Date Issued 07/10 ,fi/2014 Registrar of Vital Statistics \ I r q;
/ (signature)
District Number 4601 Place Schenectady
'y` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LLI Date of Disposition - (S It( Place of Disposition Zitiii,, 6 ofrua
2 (address)
ttl
(section) (lot number (grave number)
t
i Name of Sexton or Person in Charge of Premises ifrItt j /6T-
Z lcaec print)
L1 Signature L,_ Title C(Zm
(over)
DOH-1555 (02/2004)