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Bondy, Robert NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert M. Bondy Male Date of Death Age If Veteran of U.S. Armed Forces, : September 26,2014 57 War or Dates ` Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death X Natural Cause Accident Homicide n Suicide Undetermined Pending Investigation 4 Circumstances Vc Medical Certifier Name Title Aqueel Gillani Dr. Address 102 Park Street,Glens Falls,NY 12801 Death Certificate Filed - District Number Register Number City, Town or Village Glens Falls 5601 �� • ❑Burial Date Cemetery or Crematory September 30, 2014 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z I I Removal and/or Held 2 and/or Address ! Hold 0 Date Point of N.I I Transportation Shipment p` by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address . '• Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 s Address ry 53 Quaker Road, Queensbury,NY 12804 1: Name of Funeral Firm Making Disposition or to Whom :g. Remains are Shipped, If Other than Above Address: s Permission is hereby granted to dispose of the human remains scribed ab ve as indic ed. Date Issued 09 U / Registrar of Vital Statistics �_12 �-' • `-( (s gnature) ,r, District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILI Date of Disposition 101 1(I41 Place of Disposition Pik/ ‘r•"-.40rI,,,,,., 2 (address) ta U) IX 0 (section) /f (lot number) (grave number) Q Name of Sexton or Person in Charge of Premises A{r �,r�d Z •(please print) Lu Signature l � 4.,.. Title C1if,tlittOle. (over) DOH-1555(02/2004)