Purdy, Robert Marshall LF
NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Marshall Purdy Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/22/2023 88 Years War or Dates Army
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
,p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ElPending
Circumstances Investigation
W Medical Certifier Name Title
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 551
I Burial Date Cemetery,Crematory or Facility Name
09/27/2023 Pine View Cemetery
Entombment Address
Cremation Queensbury,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
A Hold Address
0
a Date Point of
Cl) Transportation
ES Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
a Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/25/2023 Registrar of Vital Statistics DiLCon Moran(ECectronicalty Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IF—
W Date of Disposition C,a 1 . yj Place of Disposition Q1 1 4 R. R� Ta � ��� /cFkinAl
(address)
w nei dG I aaA 1
Cl) (section) 6:21 �totnumber) (grave number)
GName of Sexton or Person in Charge of Pre ' es ''�n -7Uc" ��
(please print)
W Signature iyr, .L Title
DOH-1555(07/t8)p 1 of 2
-Public Health Law Sec. 4145(2b) U 12999
Receipt
. _
Human remains of
.
delivered on / , 20
" Pine View Cemetery Representing the funeral home named du burial permit
Official Funeral Directors Reg.or License#
'4\ 1
Foray
(1.5 Lot No.
]22 A
Address 75 Country Club Rd. , Glens Falls. N.Y. 12801 Section No.
Owner Robert & Patricia Purdy Plot Oneida
Date 8/2/85
Approx. 67 Superficial ft. @
Location Bounded North by King South by Vacant. East by Path. West by Vacant & Hatfield
Corner Posts
Remarks
Deed No. (and changes) 1947
Payment Record Paid in Pull 8/2/85
Record of Interments
1 �� ���acc . G 1 a� -T
2
1:
4 I cl
' C N
5 N
6 9 w
7 I l� S
8
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Voz c a.wT f e-(arr-et d
Form No. 01
PURDY L _
NAME Robert Marshall Purdy Age: 88
Lot Owner: Robert & Patricia Purdy
Lot# Oneida 122 A Grave# 1
Case: Concrete
Died: 9.22.23. Interred: 9.2 7.2 3
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View