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Moser, Robert Francis • flt/NEW YORK STATE DEPARTMENT OF HEALTH Bu rial of Vital Records - Transit Permit Name First Middle Last Sex Robert Francis Moser Male Date of Death Age If Veteran of U.S.Armed Forces, 02/14/2024 81 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 IILI U Circumstances Investigation CMedical Certifier Name Title Asim Chaudry MD 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 96 Burial Date Cemetery,Crematory or Facility Name 02/16/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York DDonation 0❑Removal Date Place Removed F and/or and/or Held N Hold Address O O. Date Point of CO❑Transportation p 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 I— Remains are Shipped,If Other than Above 2 Address IX ILL O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2024 Registrar of Vital Statistics Megan.Arofin(Electronically 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: I— W Date of Disposition /7,20,2y Place of Dispositionc-P id( ii P✓,1 Cr04 l z( 2 (addre W U) LC (section (lot numb/er) (grave number) gName of Sexton or Person in Charge o Premis7.: 4-y/no •iA 1r/:."t� z / (please print) Ill Si nature ) `,°ot f •"0` Title G&PS4 g ! DOH-1555(o7/18)p 1 of 2 -e- - Public Health Law Sec. 4145(2b) ` ' 0: ..:' Receipt Human remains of delivered on , 20 f 1 1 1 Pine View Cemetery View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#