Klingenberg, Lothar Erich NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Lothar Erich Klingenberg Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/21/2021 62 Years War or Dates 1977-1980
i.. Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 103 Sanford Street,Glens Falls,New York 12801
p Manner of Death NI Natural Cause Accident Homicide Suicide 0 Undetermined Pending
0 Circumstances Investigation
UJ Medical Certifier Name Title
a
William Parker MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 52
0 Burial Date Cemetery,Crematory or Facility Name
Entombment 01/26/2021 Pineview Crematorium
Address
ElCremation Queensbury Town,New York
Donation
ZEl Removal Date Place Removed
p and/or and/or Held
N Hold Address
0
N❑Transportation Date Point of
G by Common Shipment
Carrier Destination
IDDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Radloff Funeral Home Inc 01425
Address
136 Warren St,Glens Falls,New York 12801
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
a Address
CC
W
Q. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/26/2021 Registrar of Vital Statistics Robert Andrew Curtis(ECectronicaQySigned)
/signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition "Z') ).11 Place of Disposition 'net . 7^4,`
iii
a (address)
W
N
8 (section)
Allot number) (grave number)
Name of Sexton or Person in Charge of Pre 'see I 1 ti1 ,A,A1 ft
,Z L //67 '� 1pl e print)
IJ
Signature T Title /la/PNITN.
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 141 6
I'.
Receipt
Human remains of delivered on , 20
- Pine View Cemetery Representing the funeral home named on,burial permit
Official Funeral Directors Reg.or License# ! ''