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Manning, Robert E _ (LF) jsq NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert E.Manning Male Date of Death Age If Veteran of U.S.Armed Forces, 11/23/2023 88 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 105 Dankers Road, Johnsburg Town, New York 12843 W Manner of Death Pending W El NaturalCause Accident Homicide Suicide Undetermined El Circumstances Investigation W Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 49 Burial Date Cemetery,Crematory or Facility Name 11/29/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of U)❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/28/2023 Registrar of Vital Statistics Jean MComstock(ECectronicaCCySigned) (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 l)_Z 9 j�3 Place of Disposition Pj ,L /;e sAl C r-'LU 2 (address) W CC U) (section) (lot number)1 (grave number) gName of Sexton or Person in Cha of Premises I ? Ja 1 t4 0 eel 1>. t cv, (please pr W 1 int) Signature l&j �� Title pP�'� �r DOH-1555(o7/18)p t of 2 r: y 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#