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Dobert, Gary B
(13c. NEW YORK STATE DEPARTMENT OF HEALTH •� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gary B Dobert Male Date of Death Age If Veteran of U.S.Armed Forces, 11/22/2020 77 Years War or Dates 1966-1969 Place of Death Hospital,Institution or WCity,Town or Village Albany Street Address Albany Medical Center Hospital 1p Manner of Death © Natural Cause ElAccident Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title 0 Olga Martin PA Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2520 Burial Date Cemetery,Crematory or Facility Name 11/24/2020 Pine View Crematory ❑Entombment Address ]Cremation Queensbury Town,New York Donation Removal Date Place Removed p and/or and/or Held N Hold Address 0 0.. Date Point of co Li Transportation S by Common Shipment Carrier Destination El Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/23/2020 Registrar of Vital Statistics 'DaniefTe S Gillespie(ECectronicalTy Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z .. Lam✓1�-- Date of Disposition (i 11y 110 Place of Disposition 2 (add ss) W CC (section) (lot numbe (grave number) 8 Name of Sexton or Person in Charge of raises Ch rss L< NIA4(I4 Z (p e'se print W Title C � Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) {.�14 2 2 7 Receipt Human remains of delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#