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Gadway, Robert Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Joseph Gadway Male Date of Death Age If Veteran of U.S.Armed Forces, 01/14/2024 52 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 108 Adrondack Street,Queensbury Town, New York 12804 p Manner of Death ❑X Natural Cause Accident 0Homicide Suicide ❑Undetermined Pending VCircumstances Investigation LU Medical Certifier Name Title CI Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 11 Burial Date Cemetery,Crematory or Facility Name 01/19/2024 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York ❑Donation Q❑Removal Date Place Removed h and/or and/or Held N Hold Address 0 O. Date Point of U)❑Transportation a by Common Shipment Carrier Destination ElDisinterment 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 te Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/18/2024 Registrar of Vital Statistics Caroline JfiCdegartfe Barber(E(ectronica1 y Signed) /signature/ District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 1123 II' Place of Disposition f, r J Ctk rnAW2th-- W I (address) CC (section) / (lot number (grave number) Name of Sexton or Person in Charge of Premises 6 A (,e\. 'Fs �r ) ease print) W Signature Title / 4 i1l/ DOH-1555(07/18)p 1 of 2 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#