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Austin, Robert O
• NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert 0 Austin Male Date of Death Age If Veteran of U.S.Armed Forces, 06/04/2021 72 Years War or Dates 1970-1972 ZPlace of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 237 ❑Burial Date Cemetery,Crematory or Facility Name 06/08/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held "' Hold Address O la. Date Point of (0 ❑Transportation aby Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address f ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above SE Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/08/2021 Registrar of Vital Statistics &6ert Anufrew Curtis(ECectronicalty 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: Date of Disposition (alit)it)/Z 1 Place of Disposition 1,1._ 'li-•••••••, (address) Si (sedan/ (lot number) (grave number) Name of Sexton or Person in Charge of Premis t11M �t"th4i Z �� (p/ee print) /' �,�p W Signature / Title ` �1 "e DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 011 4 6 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#