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Magditz, Robert Sterling �- gc NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Sterling Magditz Male Date of Death Age If Veteran of US.Armed Forces, 09/27/2023 76 Years War or Dates 1967-1968 Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address 2211 Garnet Lake N Road,Johnsburg Town,New York 12843 0 Manner of Death �Natural Cause Accident Homicide Suicide Undetermined Pending IJJCircumstances Investigation W Medical Certifier Name Title G Robert Southerland MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 41 Burial Date Cemetery,Crematory or Facility Name 10/02/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ El Removal Date Place Removed and/or and/or Held H Hold Address O ' a Date Point of N) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CE uJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/29/2023 Registrar of Vital Statistics jean M Comstock(ECectronicaf(y Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 1013I13 Place of Disposition P±i,EtiF„c,,4.0cd CP ?eTUQti (address) W Q (section) (lot number (grave number) SName of Sexton or Person in Charge of Prem. Z k _ lease print/ W Signature Title leivArItGe DOH-1555(07/18)p 1 of 2 0 .. I333 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#