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Brown, Robert Edward NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Edward Brown Male Date of Death Age If Veteran of U.S.Armed Forces, 07/20/2021 82 Years War or Dates i.., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 1p Manner of Death ©Natural Cause Accident Homicide Suicide El Undetermined El Pending Circumstances Investigation tU Medical Certifier Name Title G Matthew Loftus PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 306 Burial Date Cemetery,Crematory or Facility Name 07/23/2021 Pine iew crematorium EjEntombment Address ElCremation Queensbury Hamlet,New York Donation _ Removal Date Place Removed and/or and/or Held — Hold Address fR ❑Transportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom t— Remains are Shipped,If Other than Above Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/23/2021 Registrar of Vital Statistics 4i96ertAnofrew Curtis(ECectronicaQySigned) (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: n LiZ Date of Disposition ��/�v�( Place of Disposition P;.4j ���� l fe A r (address) W CC (section) (lot number) (grave number) Name of Sexton or Person in Charge f Premises ,�5` v,�� E• 0a0J. z (please print) W Signature •//I Titles DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) L.i 1 4 9 70 Receipt Human remains of i delivered on , 20 Pine View Cemetery Representing the fungal.home named on burial permit 7 Official Funeral Directors Reg.or License#