Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Swain, Robert M
- IC.LIF:\ # szs NEW YORK STATE DEPARTMENT OF HEALTH BUrld� - Transit Permit Bureau of Vital Records m Name First Middle Last Sex Robert M.Swain Male Date of Death Age If Veteran of U.S.Armed Forces, 06/25/2023 68 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death El Natural Cause Accident ❑Honiicide Suicide Erndetennined I-1 Pending 0 Circumstances Investigation WW Medical Certifier Name Title Marvin Davidowitz 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 315 Burial Date Cemetery,Crematory or Facility Name 06/28/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held • • Hold Address 0 d- Date Point of Cl) Transportation p by Common Shipment Carrier Destination Disinterment E Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above ▪ Address CC W' IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/28/2023 Registrar of Vital Statistics Megan Train(ECectronicalTySigned) (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: Z LU Date of Disposition 4 ,ZaiZ3 Place of DispositionL 4--- 2 (address) W cc (section) � (lot number/ (gave number) O Name of Sexton or Person in Charge of Pre ises `r� it J /i ase print) Ui Signature Title (Pgt116(72 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) r'1 Receipt Human remains of delivered on , 20' Pine View Cemetery ' Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#