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Lindsey, Robert J.
1311 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert J.Lindsey Male Date of Death Age If Veteran of U.S.Armed Forces, 04/03/2021 81 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause 1=1Accident Homicide Suicide ❑Undetermined ❑Pending LU U Circumstances Investigation 0 Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 166 ❑Burial Date Cemetery,Crematory or Facility Name 04/05/2021 Pine View Crematory 0 Entombment Address lCremation Queensbury Town, New York 0 Donation ZEl Removal Date Place Removed H and/or and/or Held N Hold Address 0 O. 1-1 Date Point of co Li Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC W Li_ 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: F- 4 WDate of Disposition Li IS I'Zf Place of Disposition gu.(1.... ,o.-- 2 (address) W U) CC (section) / lot number) [�� (grave number) gName of Sexton or Person in Charge of Premise - (plea* /.�� 'h^^milA Z (plea print) / UJ Signature Title C efii 'ti(€ DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) ` s 14 t Receipt Human remains of 1 delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#