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McCabe, Robert W. • NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert W.McCabe Male Date of Death Age If Veteran of U.S.Armed Forces, 12/23/2021 62 Years War or Dates F. Place of Death Hospital,Institution or Iil City,Town or Village South Glens Falls Village Street Address 129 Saratoga Avenue,South Glens Falls Village,New York 12803 Manner of Death © Natural Cause El Accident Homicide Suicide 0 Undetermined 0 Pending W Circumstances Investigation QW Medical Certifier Name Title Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa Village,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 28 ElBurial Date Cemetery,Crematory or Facility Name 12/28/2021 Pine View Crematory El Entombment Address Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held N Hold Address 1-1 O Q. Date Point of U) ❑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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 2 Address LC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2021 Registrar of Vital Statistics Joy Bartholomew(Electronically Signed) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition /� Z P—11 Place of Disposition 9%rt.. V,c,t) C,rtrk ¢arY 2 (address) W N CC (section) (lot number) (grave number) GName of Sexton or Perso in Charge of Premises J<.ft {,y' �1�( ,.r (please print) W Signature f�?fi Title re"4'`•'�G/ DOH-1555(07/18)p t of 2 • i 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#