Lynch, Robert Edmond NEW YORK STATE DEPARTMENT OF HEALTH �2 �� •
Bureau of Vital Records Burial - Transit Pe �t
Name First Middle Last Sex
Robert Edmond Lynch Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/25/2022 69 Years War or Dates
. Place of Death Hospital.Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILI Manner of Death
W ElNaturalCause DAccident 0 Homicide Suicide DUndetermined ❑Pending
✓ Circumstances Investigation
EMedical Certifier Name Title
William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cr
0,Town or 5601 288
Burial Date Cemetery,Crematory or Facility Name
051
27/2022 Pine View Crematory Address
Cremation Queensbury Town,New York
DDonation
ZURemoval Date Place Removed
p and/or and/or Held
N Hold Address
0
Transportation Date Point of
by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
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
2 Address
IL
W
O Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/2612022 Registrar of Vital Statistics Megan Aran t rectmnrcaQ',Stkneop
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition S 2B—Zozz Place of Disposition e de V i e ti t� u
address/
W
CC (section) (lot number/ I (grave number)
8 Name of Sexton or Person in Charge of remises f y/71 b.41-6 t..i[ac? CI
Z (please print)
W Signature4j Title e2i.t
DOH 1555(07/18)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 huri71 permit
Official Funeral Directors Reg.or License#