Robbins, April T # Va
NEW YORK STATE DEPARTMENT OF HEALTH E At
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
April Lynn Robbins Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 27, 2012 41 War or Dates
.F- Place of Death Hospital, Institution or
Zuj City, Town or Village Glens Falls Street Address Glens Falls Hospital
W' Manner of Death❑ Natural Cause Accident �Homicide � Suicide Undetermined a Pending
Circumstances Investigation
WW Medical Certifier Name Title
CI Paul Bachman, M.D.
Address
3767 Main Street Warrensburg, NY 12885
Death Certificate Filed ,,..- E n
District Number 5 Registe ber
City, Few or V lege-. Vr le A S f"'t-'(/ D vc
❑Burial Date Cemetery or Crematory
May 30, 2012 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z El Removal and/or Held
and/or Address
p_ Hold
(I'? Date Point of
e. 0 Transportation Shipment
(t) by Common Destination
8 Carrier
Date Cemetery Address
a Disinterment
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
IX
L2. Permission is hereby granted to dispose of the human remains described above as•indicated.
Date Issued Jl' ) 3 j it 2 Registrar of Vital Statistics (.. 3c ,\_2 LA)
(signature
District Numbe�,r-�'�3/ Place 67&' ic-41/S,A?y f�2r /
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 5/31 112 Place of Disposition P.Ut4,44 Civrttorw*--
a (address)
W
0
re (section) Art (lot number) (grave number)
to Name of Sexton or Perso )n Charge of P emises {ww
(please print)
W` Signature 41 Title CAM d�
9 it e
(over)
DOH-1555 (02/2004)