Reed, Robert Allan NEW YORK STATE DEPARTMENT OF HEALTH r' Burial — Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Allan Reed Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/07/2021 48 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 58 Ogden Road,Queensbury Town,New York 12804
(3 Manner of Death Natural Cause 0 Accident Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
Michael Adams MD
Address
1299 9 Route,Gansevoort Hamlet, New York 12831
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 188
X❑Burial Date Cemetery,Crematory or Facility Name
09/14/2021 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
▪Donation
g Removal Date Place Removed
and/or and/or Held
- Hold Address
0
O. 1-1 Date Point of
0) ❑Transportation
El 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-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
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 09/09/2021 Registrar of Vital Statistics Caroline 2CiCclegarde Barber(6Cectronically Signed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IF—
W Date of Disposition 9 . 1 5.2 0 2 1 Place of Disposition 21 Quaker Rd. Queensbury, NY 12804
2 (address)
W Erie 29G 1
CC CC (sedion) (lot number) (grave number)
• Name of Sexton erson in Charge of Premises Connie Goedert
Z (please print)
W Signature - Title Superintendent
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 012872
Receipt
.�-t Y
Human remains of �` ` ilk-' `� delivered on- x-' ' � , 20',
i
Pine View Cemetery ` Representing the funeral home named on burial permit
Official ` f Funeral Directors Reg.or License#
REED
NAMERobert Allan Reed L.I 1 Age: 48
Lot Owner: Lucy Reed
Lot# Erie 29G Grave# 1
Case: Concrete
Died: 9.7.2 0 21 Interred:9.15.2021
Funeral Home: M.B. Kilmer FH
Cemetery: Pine View