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Blinstrubas, Robert John 4) 3/ C NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert John Blinstrubas Male Date of Death Age If Veteran of U.S.Armed Forces, 04/20/2021 66 Years War or Dates • Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide Undetermined 0 Pending UCircumstances Investigation O Medical Certifier Name Title Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 188 Burial Date Cemetery,Crematory or Facility Name 04/23/2021 Pine View Crematory 0 Entombment Address k❑Cremation Queensbury Town,New York Donation ZRemoval Date Place Removed p and/or and/or Held N Hold Address 0 d 1-1 Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address _ Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 2 Address CC W n Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/22/2021 Registrar of Vital Statistics qp6ertAndrewCurtis(ECectronicaltySigned) (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: r7 W Date of Disposition 11/13f Z' Place of Disposition t,`IL l r-- 2 (a dress) W U) CC (section) (lot numb (grave number) 0 Name of Sexton or Person in Charge of Premises /i,,fi)Z— A..-444 Z i7 './, (pleate print) / W Signature Li/ Title [ Ii✓"ki2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Y -4 7 Receipt Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#