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Ash, Robert John Sr. OLF -tr 5- 'l NEW YDRK STATE DEPARTMENT DFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert John Ash Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 01/13/2024 82 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death El Natural Cause Accident El Homicide 0Suicide Undetermined El Pending O Circumstances Investigation W Medical Certifier Name Title C Matthew Loftus PA 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 30 Burial Date Cemetery,Crematory or Facility Name 01/16/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation cl Removal Date Place Removed and/or and/or Held N Hold Address NTransportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above a Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/16/2024 Registrar of Vital Statistics Megan NoCin(ECectronicalty 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: Z W Date of Disposition 11)1 I 2y Place of Dispositionrt,r644 i ',g„+1q` L.__ 2 (address) Ill N (section) (lot number) S (grave number) CCa\t, o Name of Sexton or Person in Charge of Premises //, V �.-- waft Z dI G (p se print) W Signature Title tPeivATJ'C DOH-1555(07/18)p 1 of 2 } fi7;' 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#