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Layton Sr., Robert William c3 z NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert William Layton Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 06/28/2023 86 Years War or Dates Air Force Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 84 Forest Drive,Queensbury Town,New York 12845 'p Manner of Death a Natural Cause Accident Homicide ESuicide Undetermined El Pending Circumstances Investigation C.) W Medical Certifier Name Title 0 David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number Town or Village 5657 100 Burial Date Cemetery,Crematory or Facility Name 06/30/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation goRemoval Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of Transportation a by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 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 06/30/2023 Registrar of Vital Statistics Caroline xCdegarde Barber(2fectronicatty Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z IL Date of Disposition Z a Place of Disposition P. (-) C' Cr' ,sLr 2 (address W (section) ((lot number) (grave number) 0 Name of Sexton or Person in Charge f Premise/7 I/34o j�l1Dl1cl Z (please print) W Signature Title A i DOH-1555(07/18)p l of 2 1. u Public Health Law Sec. 4145(2b) 1 Receipt 1 Human remains of i delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#