Tripp, Robert Gordon c
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Gordon Tripp Male
Date of Death Age If Veteran of U.S.Armed Forces, •
07/19/2021 77 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
O Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 302
❑Burial Date Cemetery,Crematory or Facility Name
07/22/2021 Pine View Crematory
EjEntombment Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
~ Hold Address
0
d Date Point of
Cl) ❑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
g Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/22/2021 Registrar of Vital Statistics 906ert.,,Inrfrew Curtis.gkctronicall51Signer)
(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:
Z Date of Disposition 1 23 I'ti Place of Disposition t�
l!J address)
W
CC (section) (lot number) (grave number)
c, Name of Sexton or Person in Charge of Pre, ises
IA (.s L
(p se print)
W Signature Title �� ���
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)-- 14 4 963
Receipt
Human remains of delivered on - , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#