Loading...
Imrie, Roibert John NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert John Imrie Male Date of Death Age If Veteran of U.S.Armed Forces, 10/27/2023 68 Years War or Dates F- Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 45 Geer Street,Glens Falls,New York 12801 'p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 501 Burial Date Cemetery,Crematory or Facility Name 10/30/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of N Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address EIReinterment 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 1— Remains are Shipped,If Other than Above M Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/30/2023 Registrar of Vital Statistics Megan No(in(E(ectronica1Ty Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition t I I 1 I 73 Place of Disposition 'C P$ew CR ►'11orrlit UaN (address) DJ CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises 7/t. �,w,Mft Z J (lease print) W Signature / Title `ia jam( DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 0 1- ��2 0 Receipt Human remains of I delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#