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Clench, Robert James
L.F.) 6g6 0. NEW YORKSTATE DEPARTMENTOF HEALTHBurial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert James Clench Male Date of Death Age If Veteran of U.S.Armed Forces, 08/21/2023 81 Years War or Dates 1961-1967 p... Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital W Manner of Death ❑X Natural Cause ❑Accident El Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title 0 Elsa Kassardjian MD Address 43 New Scotland Ave,Albany,New York 12208 DeaRth Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 1953 Burial Date Cemetery,Crematory or Facility Name 08/26/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or El and/or Held N Hold Address a�Transportation Date Point of by Common Shipment Carrier Destination ODisinterment Date Cemetery Address IDReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom . }•. Remains are Shipped,If Other than Above 2 Address LC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/22/2023 Registrar of Vital Statistics (Danieule S Gillespie(EfectronicaaySigned) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t- W Date of Disposition �Z�-Zoz3 Place of Disposition ?,fie 14f.) Ct4�4,4o?-ic (address) W it (section) (lot number) 1 (grave number) 2 Name of Sexton or Person in Charge o Premises kp 1/4.a.4 ihoe Z (please print) W Signature J `� Title O(V2i. 1Dt.-- DOH-1555(07/18)p 1 of 2 1 4.411# .) ' Public Health Law Sec. 4145(2b) .... .... I., Receipt , , Human remains of l- r.' ', , . ' ' ' /, delivered on / ) /,'-' , 20 _ / , ...., ": '. --`, './../':, r :, ,,, Pine View Cemetery Representing the fuderal homeliamed on burial permit Official Funeral Directors Reg.or License