Viele, Robert Frederick NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records '-
Name First Middle Last Sex
Robert Frederick Viele Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/02/2021 76 Years War or Dates
p Place of Death
Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause 1=1 Accident ❑Homicide ❑Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 165
Burial Date Cemetery,Crematory or Facility Name
04/05/2021 Pine View Crematory
EiEntombment Address
®Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
O
a Date Point of
CO LI Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
ElDisinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/05/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed)
(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:
Z
Date of Disposition LI/lo 1 14 Place of Disposition
(address/
W
CC
(section) (/o. umber) (grave number)
r �pL�—►�, d
0 Name of Sexton or Person in Charge of Premises (pleaseprr,N
LU /
W Signature C Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01. 4694
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#