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Blanchard, Robert Allen Jt- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permitb Bureau of Vital Records Name First Middle Last Sex Robert Allen Blanchard Male Date of Death Age If Veteran of U.S.Armed Forces, 11/04/2021 71 Years War or Dates Navy Place of Death Hospital,Institution or • City,Town or Village Glens Falls Street Address Glens Falls Hospital tp Manner of Death ©Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title Julian Marynczak PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 493 ❑Burial Date Cemetery,Crematory or Facility Name 11/08/2021 Pine View Crematory 0 Entombment Address lCremation Queensbury,New York ❑Donation Z• Removal Date Place Removed and/or and/or Held H Hold Address 0 a. Date Point of co Li Transportation p by Common Shipment 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 - Remains are Shipped,If Other than Above 2 Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2021 Registrar of Vital Statistics R96ertAndrew Curtis(ECectronically 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 I I c1 "Li Place of Disposition �1L a r„ 2 (address) dd W Q (section) � (lot number) 1 (grave number) 8 Name of Sexton or Person in Charge of Pre ises (-> S-tv,,,A�V Z (please print) ���p/ W Signature 6".' Title 1c?c.4'��C< DOH-1555(07/18)p 1 of 2 fc r., Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#