Sloan, Robert Edward LF\ # 5g
NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Edward Sloan Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/20/2022 73 Years War or Dates 1970-72
Place of Death Hospital,Institution or
Z City,Town or Village Ballston Spa Village Street Address 41 N High Street A,Ballston Spa Village,New York 12020
W EUndetermined
Manner of Death Natural Cause Accident Homicide Suicide C d Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Village Of Ballston Spa District Number Register Number
City,Town or Village 4520 20
Burial Date Cemetery,Crematory or Facility Name
10/25/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Q❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
d Date Point of
Cl)❑Transportation
by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
CC
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/25/2022 Registrar of Vital Statistics Teri Lee OConnor(Electronically Signed)
(signature)
District Number 4520 Place Village Of Ballston Spa
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition lollS(ZZ Place of Disposition
W
(address)
LU
CC U) (section) pot number) (grave number)
Name of Sexton or Person in Ch f Premises r't L n
Z ease pr
W fAf
Signature Title (r am/Ap
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 burial permit
Official Funeral Directors Reg.or License#