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Meyerhoff, Robert J
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert J.Meyerhoff Male Date of Death Age If Veteran of U.S.Armed Forces, 05/02/2023 84 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital • Manner of Death ❑^ Natural Cause IllAccident 0 Homicide ESuicide FlUndetermined []Pending W Circumstances I 'Investigation W Medical Certifier Name Title Scott Biasetti 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 226 Burial Date Cemetery,Crematory or Facility Name 05/03/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation 0❑Removal Date Place Removed and/or and/or Held t- Hold Address U) 0 d Date Point of (/)❑Transportation Shipment Esby Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address CReinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom (... Remains are Shipped,If Other than Above Address CC W Ct' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/03/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (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: WDate of Disposition (" Place of Disposition (address) W (section) A (lot number��\ (grave number) SName of Sexton or Person in Charge of P miles n- .V z l6lease print)� �W Signature Title ` DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on bural permit Official Funeral Directors Reg.or License#