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Gillespie, Robert Lionel
ti- ,---7--, (401Z NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Lionel Gillespie Male Date of Death Age If Veteran of U.S.Armed Forces, 08/07/2023 59 Years War or Dates 1— Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death [1 Natural Cause []Accident El Homicide 0Suicide nUndetermined []Pending W ✓ Circumstances I 'Investigation W Medical Certifier Name Title C3 Christopher Smith 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 376 dBurial Date Cemetery,Crematory or Facility Name 08/10/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of CO❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address C Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above " Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/10/2023 Registrar of Vital Statistics Megan.Noln(EYectronicall:y Signer19 (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: l— W Date of Disposition g/(I(73 Place of Disposition '► :,._� . 4— (address) W CCCC (section) i(lot number) (grave number) 0 Name of Sexton or Person in Charge f Premises `" Sn-4 h" �%l / (P erese print) LU [a ,/ W Signature Title DOH-1555(07/18)p 1 of 2 7 7 P L I. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine Vieiv Cemetery Representing the funeral home named on buriaLpermit Official Funeral Directors Reg.or License#