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Neusel,Robert G.
S. a It 717 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Robert G.Neusel Male Date of Death Age If Veteran of U.S.Armed Forces, 21 78 Years �, 02/23/20 War or Dates F= Place of Death Hospital,Institution or MI City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death ©Natural Cause Accident Homicide ❑Suicide W Undetermined Pending U Circumstances Investigation CI Medical Certifier Name Title Diane Westbrook NP Address , 131 Lawrence St,Saratotittptings,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Spring so 4501 165 ElBurial Date Cemetery,Crematory or Facility Name e 02/25/2021 Pine View Crematory ki_ L. Entombment Address ElCremation Queensbury Town,New Yc , Li Donation OZ Date Place Removed ❑Removal -a and/or and/or Held N Hold Address 0 N ❑Transportation Date Point of p by Common Shipment Carrier Destination , El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom _ Remains are Shipped,If Other than Above Address IX W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/24/2021 Registrar of Vital Statistics John Paul franck(ECectronica1TySigned) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 214 4 Tj Place of Disposition .1L Z�itor,,ti W 2 (address) W N Q (section) I (lot number) c (grave number) 8' Name of Sexton or Person in Charge of Premises �'�t'Q J�+n.t 6} z (plelase print) W aiSignature Title t '" }Ilk DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 14' 5 8 6' Receipt Human remains of i delivered on , 20 I f , { Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#