Bowen, Robert L. Sr. NEW YORK STATE DEPARTMENT OF HEALTH ICF Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert L.Bowen Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/27/2022 89 Years War or Dates Korea
F., Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death El Natural Cause IllAccident [IIHomicide El Suicide ElUndetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
G William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 544
K Burial Date Cemetery,Crematory or Facility Name
11/02/2022 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
o111Removal Date Place Removed
and/or and/or Held
F— Hold Address
N
0
Date Point of
(A Transportation Shipment
G by Common
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
CC
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/31/2022 Registrar of Vital Statistics MeganNvrn(EkctronicalySignerl)
(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 ivy / Ai
W �
Date of Disposition I I 9 � Place of Disposition �/ ,( / �r! 1� �-� �(.! cl�5 r
(address)
w —M1 01t
1ccan 029
c �(lottnnumber) (grave number)
0 Name of Sexton or Person in Charge of Prem. %)fl i we c- .
(please print)
lU Signature 4. Title , n i-1
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
0.12950
Receipt
Human remains of i' delivered on , 20
7'Pine°Cr e ,&! metery Representing the funeral home named on burialpermit
Official Funeral Directors Reg.or License#
BOWEN !
LF
NAME Robert L. Bowen Sr. Age: 89
Lot Owner: Robert & Lorraine Bowen
Lot# Mohican 29 B Grave# 1
Case: Concrete
Died: 1 0 .2 7.2 2 Interred: 1 1 .2 .2 2
Funeral Home: Regan Denny Stafford
Cemetery: Pine View