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Harder, Robert Jay 4 LOF it z s--? NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Robert Jay Harder Male Date of Death Age If Veteran of U.S.Armed Forces, 03/07/2024 79 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death fj Natural Cause Accident ❑Homicide Suicide Undetermined ri Pending U Circumstances Investigation W Medical Certifier Name Title O 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 147 RBurial Date Cemetery,Crematory or Facility Name 03/13/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of V)OTransportation Shipment p by Common Carrier Destination O Disinterment Date Cemetery Address IIIReinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/13/2024 Registrar of Vital Statistics Megan No(in(ECectronicallySigned (signature) District Number 5601 Place City Of Glens Fails I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 3114 12i1 Place of Disposition i *T451.J C " vi'LSJ-` 2 (address) W NCC (section) i (lotnumber) (grave number) G Name of Sexton or Person in Charge of remises l� Z / ease print) W ("" Title �c4 14��C' Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) e ' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# LF Town of Queensbury 0111104. Certification of Cremation dr" Pine View Cemetery and Crematory This certifies that the remains of: Robert Jay Harder were cremated on March , 14 20 24 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death March , 7 20 24 Age 79 (Month) (Day) Funeral Home Carleton Funeral Home Registered No. 257 7 7 (Authorized Signature) HARDER IL Lot No. 34 Address 9 w- 1 Liam St-. Glens Falls, NY 12801 Section No. D Owner Mr. Robert Harder Plot Mohican Date 1/9/91 Approx. 33 Superficial ft. @ Location Bounded on North by Vacant, South by Vacant, East by Ruggles, West by Vacant. Corner Posts Remarks Deed No. (and changes) 2332 Payment Record Paid in Full 1/9/91 Record of Interments 1 Doris Elizabeth Harder 1/9/91 il R(D\,e)R-\---- -\-NCIrc\ei2 5- 00-a,-A. 13N. .)---1 , <..\ ',, / 3 ;t / 4 S 6 -1- 7 r 8 .f'. �/1-- - Form No. 01 HARDER NAME Robert Jay Harder ge: 79 Lot Owner: Robert Harder Lot# Mohican 34 D Grave# 1 A Case: Urn Died: 3 .7.2 4 Interred: 3.2 2.2 4 Funeral Home: Carletons Cemetery: Pine View