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Gebo, Robert Lee NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Lee Gebo Male Date of Death Age I If Veteran of U.S.Armed Forces, 10/04/2023 75 Years ( War or Dates 1966-1969 ._ Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 173 John Street, Hudson Falls Village, New York 12839 W Manner of Death Undetermined Pending Cause InAccident n Homicide n Suicide Circumstances Investigation Medical Certifier Name Title G Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 31 Burial Date Cemetery,Crematory or Facility Name 10/05/2023 Pine View Crematorium nEntombment Address ©Cremation Queensbury Town,New York Donation Q❑Removal Date Place Removed and/or and/or Held t- Hold Address 0 0. Date Point of (I) Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom l^ Remains are Shipped,If Other than Above Address 2 W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2023 Registrar of Vital Statistics Cynthia ardin(ECectronica1TySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /� Z Date of Disposition /Q-7Zv%3 Place of Disposition nJe /ie� L , 2 (address/ W OC (section) (lot number) (grave number) Qt Name of Sexton or Person in Charge of P ises �4/`Nd� , is c3 Z (please print) W Signature i4/ Title dP'C3714 DOH-1555(07/18)p 1 of 2 " w Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on bpial permit Official Funeral Directors Reg.or License#