Harpp, Robert Erwin LOF
NEW YORK STATE DEPARTMENT OF HEALTH �• •
Bureau of Vital Records Burial - Trans @r1111t
Name First Middle Last Sex
Robed Erwin Harpy, Male
Date of Death Age If Veteran of US.Armed Forces,
05/22/2022 58 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address Ekierwood at North Creek
ILI
`p Manner of Death ❑X Natural Cause DAccident Homicide Suicide ElUndetermined ❑Pending
✓ I—JCircumstances Investigation
0▪ Medical Certifier Name Title
Michael Miles MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 10
Date Cemetery,Crematoryor FacilityName
Burial
�42 View
022 Pine Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
F= Hold Address
N
2 Date Point of
to❑Transportation
Q by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05232022 Registrar of Vital Statistics lean.W Comstock( arV S n4O
(signature)
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition S-12S)2t Place of Disposition tic�yam ,
W (address)
W
O (section) /f pot number) sews.44 (grave number)
O Name of Sexton or Person in Charge o emises /�//1 nn �,, Zf
Z (pse print)
W Si nature Title CB£mi}�lQ
g
DOH 1555(07/18)p i of 2
r; 7 1
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#