Robbins, Debbie Lynn If
NEW YORK STATE DEPARTMENT OF HEALTH 1 1 211
-
Bureau of Vital Records BurialTransit Permit
Name First Middle Last Sex
Debbie Lynn Robbins Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/02/2020 62 Years War or Dates
ZZ Place of Death Hospital,Institution or
City,Town or Village South Glens Falls Village Street Address 22 Stewart Avenue,South Glens Falls Village,New York 12803
ILI
p Manner of Death Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined ❑Pending
WI
0 Circumstances Investigation
LU Medical Certifier Name Title
CI Gerard Abess MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village South Glens Falls Village 4524 16
Burial Date Cemetery,Crematory or Facility Name
12/04/2020 Pine View Crematory
Ei Entombment Address
0 Cremation Queensbury Town,New York
EIDonation
Z El Removal Date Place Removed
and/or and/or Held
F— Hold Address
0
d. Date Point of
CO ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F.. Remains are Shipped,If Other than Above
2 Address
CC
ILLI
q Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/03/2020 Registrar of Vital Statistics Slannon xelleler(Electronically"Srgnen)
(signature)
District Number 4524 Place South Glens Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit o •
H 21...._Z Date of Disposition tif7 170 Place of Disposition
ILI
g (address
W
ICC C (section) li (lot number) (grave number)
ifr
G Name of Sexton or Person in Charge of Pre • s ' 6 ti i L ✓/HnA�
Z (p/ se print)
W Signature Title 1-01/P+lrA1.,
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) U 1 .2 61
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# '