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Cummings, Robert Charles ti...ti—r-". ..), -g- -7 I 2, NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Charles Cummings Male Date of Death Age If Veteran of U.S.Armed Forces, 09/01/2023 75 Years War or Dates 1967-1971 1— Place of Death Hospital,Institution or ZCity,Town or Village Fort Edward Town Street Address 56 Mechanic Street, Fort Edward Town, New York 12828 Q Manner of Death El Natural Cause Accident 1-7 Homicide []Suicide []Undetermined Pending 0 I 'Circumstances Investigation G Medical Certifier .Jane Title Courtney Bowers NP Address 3 Irongate Center,Glens Falls,New York 12801 N Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 75 riBurial Date Cemetery,Crematory or Facility Name 09/05/2023 Pine View Crematory 0Entombment Address ©Cremation Queensbury Town,New York Donation 0 ill Removal Date Place Removed and/or and/or Held H Hold Address N 0 EL Date Point of M Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 }.. Remains are Shipped,If Other than Above N Address ir W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/05/2023 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 6........_ W Date of Disposition 9I W Z3 Place of Disposition 2 (address) W to CC (section) (lot number) (grave number) SName of Sexton or Person in Ch e remises L_ It z / (pl se print) W Signature C Title jlZ/=Airif DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 'I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#'�.