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Robtoy, John C NEW YORKSTATE DEPARTMENT OF HEALTH OF. ---� T I Bureau of Vital Records Burial - Transit Permit Name First Middle John C.Robtoy Last 1 Sex Date of Death Male Date 07/19/2022 If Veteran of U.S.Armed Forces, 77 Years War or Dates F.. Place of Death Hospital,Institution or W City,Town or Village Elizabethtown Town I Street Address Elizabethtown Community Hospital p Manner of Death 0 Natural Cause DAccident Homicide ❑Suicide DU ndeterm ined ❑Pending Circumstances Investigation uW Medical Certifier Name Title Jay Heald Coroner Address 7521 Court Street,Elizabethtown Town,New York 12932 Death Certificate Filed Town OtElizabethtown I District Number I Register Number Ville. 0 1552 66 Burial Date Cemetery,Crematory or Facility Name 07/29/2022 I Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation NRemoval Date Place Removed p and/or and/or Held N Hold Address 0 V1�Transportation Date Point of a 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,Oueenebury,New York 12804 Name of Funeral Firm Making Disposition or to Whom i` Remains are Shipped,If Other than Above s Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/29/2022 Registrar of Vital Statistics Janet EC MS eanxI ,Stirred) (s/gnature) District Number 1552 Place Town Of Elizabethtown I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1 ) 2 Disposition -h I/ A� Z Date of Disposition g 3 Z Place of i�� W 2 (address) W it) (seaion)CC �. (lot number/ (grave number! L 8 Name of Sexton or Person in Ch Premises ' �t ase print/Z (ple W Title li* a Tat Signature DOH-1555 to7ft1 P 1 of 2 i . — . 1 Public Health Law Sec. 4145(2b) . �� �` 1 1 1 Receipt 1 1 Human remains of k ;; , y i delivered on , 20 1 ice, , 1 Pine View Cemetery Represetiting the funeral houte narrytd on burial permit t Official Funeral Directors Reg.or License#