Higgins, Robert NEW YORK STATE DEPARTMENT OF HEALTH 44 2 SZ.Vital Records Section Burial - Transit Permit
Name First Middle., Last Sex
Robert Byrle Higgins Male
Date of Death Age If Veteran of U.S. Armed Forces,
-` April 30,2013 89 War or Dates World War II
kPlace of Death Hospital, Institution or
City, Town or Village Hartford Street Address 1 East Street
Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
ALL Medical Certifier Name Title
PH Harriet Busch Dr
„1 Address
, HHFIN,Chestertown,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village 5759 5759
❑Burial Date Cemetery or Crematory
Er�tombrr�errt May 1,2013 Pine View Crematory
Address
Ex Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
co Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
... Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
' Address
:J 3809 Main Street,Warrensburg,NY 12885
' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
lt
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.v= Permission is h re y granted to dispose of the human re a s dhscribed b eAas indicated.
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. Date Issued 5 �� Registrar of Vital Statistics ) = �
(signature)
District Number 5759 Place Hartford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W J
Date of Disposition 55 3- 3 Place of Disposition J tA4► C.c..,w,,,--
2 (address)
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N
re (section) (it number)� (grave number)
pName of Sexton or Person in Charge f Premises ►7 Ji it {
Z p/ease print)
iu
Signature l Title Ckti4MATOit
(over)
DOH-1555 (02/2004)