Sporrer, Gottlieb NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gottlieb Sporrer Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 6, 1999 89 War or Dates
Place of Death Hospital, Institution or
A. City, Town or Village Queensbury Street Address Hallmark/Queensbury
Manner of Death❑x Natural Cause ❑Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
DR. Richard S Spitzer DR.
Address
152 Sherman, Glens Fallls, NY 12801
Death Certificate Filed Distri umer� Reg ter Number
.:::::
City, Town or Village Queensburyis Is
Date Cemetery or Crematory
El Burial March 8, 1999 Pine View Cremator
Address
Cremation
Quaker Road Queensbury, NY 12804 _
Date Place Removed
0 ❑Removal and/or Held
•• and/or Address
Hold
Q Date Point of
M.N Q Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01057
Address
82 Broadway, Fort Edward, NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is herebygranted to dispose of the human emains described above as indicated.
Date Issued�lcj 1459 Registrar of Vital Statistics
(signature)
S Place Queensbury,New York
District Numbers�9
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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z e6zl
W.
Date of.Disposition.3_ Place of Disposition �tJ
(address)
Uj
(section) (lot n mb ,Q ( rave number.)
ers
0 Name of Sexto or Pon in Charge of Premises����
g {please print)
Signature Title J /
DOH-1555 (10/89) p. 1 of 2 VS-61