Knowles, Robert NEW YORK STATE DEPARTMENT OF HEALTH \* ' /r
Vital Records Section Burial - Transit Permit
`- Name First n Middle Last Sex
Robert A. Knowles Male
Date of Death Age `; If Veteran of U.S. Armed Forces,
September 18, 2018 85 Waror Dates
1,,,. Place of Death Hospital, Institution or
W' City, Town or Village Warrensburg Street Address 37 James Street
p Manner of Death I XI Natural Cause l Accident I I Homicide Suicide Undetermined Pending
UCircumstances Investigation
tu Medical Certifier Name Title
Ci Dr.John Rugge,MD
Address
HHHN,North Creek,NY 12853
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
❑Entombment September 25,2018 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
! Hold
Cl)
0 Date Point of
is I I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
' Address
3809 Main Street, Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
h; Remains are Shipped, If Other than Above
2 Address
01,
a.
Permission is hereby granted to dispose of the human r ains desc 'bed above as indicated.
Date Issued 9-20-18 Registrar of Vital Stati 'c
(signature)
District Number 5660 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of ininD accordance with this permit on:
W Date of Disposition iltbitt f Place of Disposition 1'�U `..../uric.,
m (address)
W
0 a (section) 1 (lot number (grave number)
p Name of Sexton or Person in Charge of Premises Arc001.f.- )44441
Z (pkase print)
W
Signature2
s Title `rt I�Plf14,
(over)
DOH-1555 (02/2004)