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Newton, Robert Thornton Jr.
-4N - , tfr- ) (.1, NEW YORK STATE DEPARTMENT OF HEALTH L Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Thornton Newton Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2024 84 Years War or Dates Navy 1.. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title CI David Cunningham MD Address ` 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 92 Burial Date Cemetery,Crematory or Facility Name 02/14/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation Es—Eland/or Removal Date Place Removed and/or Held ~ Hold Address N a Date Point of lA❑Transportation S by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment 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 1— Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/13/2024 Registrar of Vital Statistics Megan Wolin(ECectronica(CySigned) (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 2 i I S IZN Place of Disposition ,�aut<OlLtJ /"P.LJN}i1V2 r--, 2 (address) W N Q (section/ �� (lot null (grave number/ O Name of Sexton or Person in C Premises r s' �-- Z Z (please print) W Signature Title C mt Mit 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# - .-