Tougaw, Robert Alfred NEW YORKSTATE DEPARTMENT OF HEALTH # /O f c
Bureau of Vital Records ' Burial - Transit Permit
Name First Middle Last Sex
Robert Alfred Tougaw Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/17/2022 82 Years War or Dates 1957-1977
Place of Death Hospital,Institution or
W City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center
'p Manner of Death II Natural Cause Accident Homicide Suicide Undetermined riPending
V Circumstances Investigation
C Medical Certifier Name Title
Zvi Batash MD
Address
3230 Church St,Valatie Village,New York 12184
Death Certificate Filed Village Of Valatie District Number Register Number
City,Town or Village 1023 63
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
8❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
Date Point of
N Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2022 Registrar of Vital Statistics Bar6ara Ann Tischer(ECectronicallySigned)
(signature)
District Number 1023 Place Village Of Valatie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /2-2 Z-?__Place of Disposition _ P K,2 tie LA)
2 (address)
W
CC
N (section) (lot umber) (grave number)
GName of Sexton or Person in Charge of ern' K".11 41/Gr✓� /l pn�
(please print)
W Signature Title 0eif 'kti4f
DOH-1555(07/18)p 1 of 2 1
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#