Bradbury Jr., Robert Milton i.
ii 32
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vitat Records
Name First Middle Last Sex
Robert Milton Bradbury Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/04/2021 96 Years War or Dates unknown
f,. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
p• Manner of Death 0 Natural Cause Accident Homicide Suicide 11 UndeterminedPending
U Circumstances Investigation
W Medical Certifier Name Title
CI Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 85
ElBurial Date Cemetery,Crematory or Facility Name
04/06/2021 Pine View Crematory
ElEntombment Address
gCremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
CL Date Point of
N Li Transportation
p by Common Shipment
Carrier Destination
0 Disinterment
Date Cemetery Address
0 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
H Remains are Shipped,If Other than Above
5 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 Carolnexkfegari Barber(i kectronicallySigned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
If—
'"'�
Z Date of Disposition y Cl Zi Place of Disposition ./,,,�,[�,,, ij6.._.
W
2 (ddress)
W
N (section) (i umber) (grave number)
3 .0 Name of Sexton or Person in Charge of Premises �`� l— �"'"�t
Z /�� (p ease print)
W Signature `'"' TitlerY""r"fl�'
DOH-1555(07/18)p 1 of 2
r
Public Health Law Sec. 4145(2b) 01 4 6 h
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#