Oreschnick,Robert William ... it _,-77
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert William Oreschnick Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/09/2022 75 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death 0 Natural Cause Accident ❑Homicide DSuicide riUndetermined El Pending
W
V I—JCircumstances Investigation
W Medical Certifier Name Title
G Shane Diamond MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 164
Burial Date Cemetery,Crematory or Facility Name
03/31/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
ElDonation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0 Date Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
ElReinterment
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
H Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/14/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ f
Date of Disposition 3�31 Z.Z. Place of Disposition (a dress)
2
W
(n°G (section) (lot number) (grave number)
F
8 Name of Sexton or Person in Charge of Premi s hi r� L .,,,.. :,pit
Z (plea print)
W Signature Title
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DOH-1555(07/t8)p 1 of 2
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# `'