Kobel, Paul 41
NEW YORK STATE DEPARTMENT OF HEALTH --2t1�
Vital Records Section Burial - Transit Permit
r;r Name First Middle Last Sex
Paul V. Kobel Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 4 2013 55 War or Dates
1. Place of Death Hospital, Institution or
Fei City, Town or Village Queensbury Street Address 200 Clendon Brook Road
Manner of Death ❑X Natural Cause U Accident n Homicide n Suicide n Undetermined Pending
w Circumstances Investigation
to
Medical Certifier Name Title
ci Dr Robert Hogan,MD
Address
Queensbury,NY
Death Certificate Filed District Number Regiisster umber
, City, Town or Village Queensbury,NY 5657
❑Burial Date Cemetery or Crematory
December 6, 2013 Pine View Crematorium
El Entombment Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
CO
Q Date Point of
N ['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
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
t- Remains are Shipped, If Other than Above
▪ Address
t
Permission is hereby granted to dispose of the human e ains des ribed ab e as indicated.
Date Issued / la-CA Registrar of Vital Statistics C�
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 10-11-13 Place of Disposition �Ul, Cowet0,-,....
2 (address)
W
CO
W (section) // (Iqt number (grave number)
p• Name of Sexton or Person in C arge of Premises ,s (?r "N
Z (please print)
W Signature Title Eira
r
(over)
DOH-1555(02/2004)