Kemmer, Robert NEW YORK STATE'DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
BID
Name First lvliddle Last Sex
_ _Robert R. Kemmer Male
Date of Death Age If Veteran of U.S. Awned Forces,
June 22,. 1997 _ 73 War or Dates_ yes U. S. Army
Place of Death Hospital, Institution or
LL City, Town or Village Glens Falls, N.Y. Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier----Name ---- Title
Robert P: Reeves M.D.
Address
3 Iron Gate Center Cornor Elm and Pine Streets Glens Falls, N.Y. 12801
Death Cer,lificate Filed District Number Register Number
City, Town or Village Glens Falls, N.Y. 5601 a8�
Date Cemetery or Crematory
❑Burial June 26, 1997 Pine View Crematory Queensbury, N.Y.
Address ---- ----- — —��
®Cremation Quaker Road Queensbury, New York 12804
Date Place Removed
z ❑Removal and/or Held
and/or ------
Address
Hold
Q Date Point of
01
Q Transportation _ Shipment
0 by Common Destination
Carti,?r
Disinterment Date Cemetery Address
Reinterrnent Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral I-tome Singleton-Healy Funeral Home 0180.1.
Address
_40_7 Bay Road Queensbury, New York 12804
Name of Funeral Finn Making Disposition or to Whom
_Remains are Shipped, If Other than Above
Address
U
Permission is hereby granted to dispose of the human rernains described above as i icated.
Date Issued June 25, 1997 Registrar of Vital Statistics
(signature)
District Number SFD] Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with
�,,thiiss permit on:
W. I f .�/�/�1.� // rl --tea 'Date of Dis position OZv� Place of Disposition /,�k� � .� /O/l /(//0
(address)
LU
cnEr (section) (lot nun er) (grave number)
0 Narne of Sexlor or Person in Charge of remises
z (please print) i-7—
W Signature Title �' O
DOH-1555 (10/89) p. 1 of 2 VS-61