Brodie, Arthur NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
in Name First Middle Last Sex
Arthur Edwin Brodie male
............---...
Mi Date of Death ii Age If Veteran of U.S.Armed Forces,
3/25/89 84 War or Dates
•:-.•••••• Place of Death Hospital, Institution or
Iti City,Town or Village city of Glens Fall Street Address Glens Falls Hospital
..........................................................................................................................................................................................................................................................
C Cause of Death
a -..--
CW70/0 Po v ,3/40-,i vo('&--s i
la Medical Certifier Name Title
1Z1 Dr J david Bannon md
Address
384 Bay_ Rd , Glens Falls,NY 12801
........................................,.............................................................................................................................................„...
Death Certificate Filed --....-...........- District Number Register Number
City,Town or Village city of Glens Falls 5601
Date Cemetery or Crematory
mE El Burial 3/28/89 ,
Pineview Cemetery
0 Cremation Address
Quaker Rd, Glens Falls, NY 12839
= Date Place Removed
0 0 Removal 1 and/or Held
.i:F
:,....,. Hold Mdress
.1.4
Date Point of
1:Transportation li
by Shipment
ii
:C1Common Carrier Destination
--. - .............—
Date Cemetery Address
0 Disinterment
Date i Cemetery Address
0 Reinterment
• •Permit Issued to Registration Number
Name of Funeral Firm
........................................C4KIQtQ11...funeral....11cme., I..,...................................................................0....5 6..................... .
mi Address
68 Main St , Hudson Falls, NY 12839
• -- • . - . - •••-•-- -
w Name of Funeral Firm Making Disposition or to Whom
m Remains are Shipped, If Other than Above
• ................................................................................................................................................................. .. . . ...................... .. • " "*"" "
ltr-Add MSS
314:
Permission is hereby granted to dispose of the human r ains described bove as indicated.
Date Issued Registrar of Vital Statistics _CE,*1- i? 9: ,...x.",„6-. A..,.)
1
_.,,.ga(si...:nature)
District Number c_.) ' Z / Place ,- g.,(4..3
- 2-ct
6, -, f
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I _j---
Z. Date of Disposition ......?-2e•-er? Place of Disposition 1—j ,t,c VI C'kLj C'- 'levk •-**‘-- V-i CaZ.l.) ..._••*_INS-S.1-i l)I--)
(address)
ALI U Ai Ca.. c 14 4.3 5
(sectior (lot number) (grave number)
la
irName of Se nor arson in Charge of Premises cs 4_ r'J e Li c•-. 1 A(t a_Eike j-
z' (please print)
ALI::
:T.:. Signature 0&.A.As7....)a,%eta-tz_a-t,"... Title 3"\..i p-if
DOH-1555(9/86)p 1 of 2(formerly VS-61)