Chandler, Robert Brian • ik)06i°
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Brian Chandler Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2021 59 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 32 Ogden Street, Queensbury Town, New York 12804
pManner of Death XI Natural Cause El AccidentEl Homicide El SuicideUndetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 244
Burial Date Cemetery,Crematory or Facility Name
12/20/2021 Pine View Crematory
Entombment Address
ElCremation Queensbury Town,New York
❑Donation
0Z Removal Date Place Removed
and/or and/or Held
H N Hold Address
0
a. Date Point of
Cl) Li Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
�... Remains are Shipped,If Other than Above
5 Address
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2021 Registrar of Vital Statistics Caroline xCdegarde Barber(E(ectronicalTySigned)
(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:
II-- f�
Z Date of Disposition �S_Z/-Z / Place of Disposition j� Ji e /ir ) (rein,c-to
ILJ
2 (address) j
W
CC
N
(sea/on) ', lot number) (grave number)
Name of Sexton or Person in Char of 7ses KA$4fl[.i b fi2vvl+
z / (please print)
W Signature �f,' Title (VC nT%C
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of k , '' ' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# .