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Kilmartin, Robert V Jr.
%.1 • ,4 -ft ri NEW YORKSTATE DEPARTMENT OF HEALTH ,. Burial - Transit Permit , k, ..., ) Bureau of Vital Records Name First Middle Last Sex Robert V Kilmartin Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2024 69 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing 0 Manner of Death El Natural Cause Accident ❑Homicide 0Suicide Undetermined ri Pending LU Circumstances Investigation W Medical Certifier Name Title G Joshua Starter' NP Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 3 Burial Date Cemetery,Crematory or Facility Name 01/23/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held NHold Address 0 O. Date Point of U) Transportation Shipment s by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom i... Remains are Shipped,If Other than Above M Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/23/2024 Registrar of Vital Statistics fenny Linda 511 Marte(Ce(ECectronicaCCySigned) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— WDate of Disposition (-,..,S-a-a._i( Place of Disposition p i c y,t, vje„� r ert Cy 2 (address) W NCC (sects) (lot number) (grave number) gName of Sexton or Person in Charge of Premises c Jr'&`/ S b''"f ,(please print) W Signature i 7 "d Title C.f t,4 ti t ( 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#