Sauer-Jones, Robert Lee ii.....F).
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NEW YORK STATE DEPARTMENTOFHEALTH ' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Lee Sauer-Jones Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/08/2022 75 Years War or Dates Vietnam
H Place of Death Hospital,Institution or
ZW City,Town or Village North River Hamlet Street Address 636 Barton Mines Road,North River Hamlet,New York 12856
O Manner of Death EI Natural Cause ❑Accident El Homicide OSuicide ❑Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
C Douglas Dennett MD
Address
101 Ridge Street,Glens Falls,New York 12801
DeaAth Certificate Filed Tavn Of Johnsburg District Number Register Number
City,Town or Village 5655 14
Burial Date Cemetery,Crematory or Facility Name
O6/10/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
®Donation
❑Removal Date Place Removed
F and/or and/or Held
N Hold Address
0
(DID-n. Date Point of
Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
' Address
Q
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/09✓2022 Registrar of Vital Statistics fears AlCO OLkt' 'tro'tha44'sigse)
(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 0/1O0 Z_ Place of Disposition /!..,4----
Wddress/
ILLI
N
CC (section) / tot number) ,,� , (grave number)
2 Name of Sexton or Person in Charg s Premises ��,4��P� `�" ��
(pleaX tvint) �,r�
W Signature Title f a �r�
DOH-1555(07/18)p 1 of 2
0 .. 5782
Public Health Law Sec. 4145(2b)
Receipt
Human remains of +t. delivered on , 20
Pine View Cemetery Representing the'funeral home named on burial permit
Official Funeral Directors Reg.or License# /` - .?-