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Monroe, Robert Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Robert Monroe were cremated on January 21 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death January 17 20 21 Age 71 (Month) (Day) Funeral Home Regan Denny Stafford Registered No. 71 (Authorized Signature) Monroe NAME Robert Monroe Age: 71 LF Lot Owner:Robert & Linda Monroe Lot# Erie 61 D Grave# 1 Case: Urn Died: 1 /1 7/2 0 21 Interred:7/2/2 0 21 Funeral Home: Regan Denny Stafford Cemetery: Pine View # I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert J Monroe Male Date of Death Age If Veteran of U.S.Armed Forces, 01/17/2021 71 Years War or Dates 1968-1974 1,,., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ,p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined ❑Pending U Circumstances Investigation W Medical Certifier Name Title G William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 35 Burial Date Cemetery,Crematory or Facility Name 01/19/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held Hold Address O a. Date Point of U) Li Transportation Shipment a by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above `„E Address CC W D. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2021 Registrar of Vital Statistics N9bertAnddrew Curtis(E(ectronica1Ty 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: ~ �L Z Date of Disposition kl f 2 Place of Disposition 2 (address) W CC (scion) (lot number) ,�{ Chof P (grave number) 0 Name of Sexton or Person in a a remises v r�S ►L �'` Z (pleaie print) r W Signature Title ` ti -- DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) = 1. 4 !� Receipt Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#