Babbitt, Robert 'It tgli
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last ! Sex
Robert D. Babbitt 1
1 Male
Date of Death Age j If Veteran of U.S. Armed Forces,
March 30, 2012 97 War or Dates Yes
1.. Place of Death Hospital, Institution or
Z City, Town or Village Argyle Street Address Pleasant Valley Infirmary
pManner of Death X Natural Cause Accident 1 I Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
C Edit K.Masaba
Address
1134 State Rt 29,Greenwich,NY 12834
Death Certificate Filed District Number�,3i Register Nurnberg
City, Town or Village Argyle `
❑Burial Date 1 Cemetery or Crematory
April 2, 2012 ' Pine View Crematorium
El Entombment Address
❑X Cremation 21 Quaker Road, Queensbury, NY 12804
Date 1 Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
NI I Transportation i Shipment
p by Common Destination
Carrier
Disinterment Date I Cemetery Address
n Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan-Minahan & Potter 01646
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
5 Address
CL
a Permission is h re y granted to dispose of the human remains described above as indicated.
Date Issued ! , - Id- Registrar of Vital Statistics 1( ,j� ,t —
(signature
District Number 5f) Jq' Place Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 114,1 1I 2q,1, Place of Disposition �,� N l�rh.til n
2 (address)
W
Cl)
re (section) (lot number) (grave number)
QName of Sexton or Pers n in Charge of Premises (i r 3 Pat
Z �� � (please print)
'
Signature �� Title Gf k
(over)
DOH-1555(02/2004)