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Forbes, Earle Robert OLF . - w gig NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name"' First Middle Last Sex Earle Robert Forbes Male Date of Death Age If Veteran of U.S.Armed Forces, 10/31/2023 59 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 111 p Manner of Death El Natural Cause ❑Accident Ei Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 505 RBurial Date Cemetery,Crematory or Facility Name 11/01/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed and/or and/or Held i H Hold Address 0 EL Date Point of N['Transportation p by Common Shipment Carrier Destination nDisinterment Date Cemetery Address IIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2023 Registrar of Vital Statistics (Megan Nolin(!Cectronicatly 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: I-- Z Date of Disposition II i 2 123 Place of Disposition "FtsJEUiCkl i( MW o;:Z„fr--, W 2 (address) W CO CC (section) g)4,..._(lot number) (grave number) gName of Sexton or Person in Charge of Pr ises \."`n,,t Z ease print) W Signature Title DOH-1555(07/18)p i of 2 7 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20, Pine View Cemetery Representing the funeral home named of burial permit Official Funeral Directors Reg.or License#