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Nims, Joseph Edward 40v NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records " Name First Middle Last Sex Joseph Edward Nims Male Date of Death Age If Veteran of U.S.Armed Forces, 04/26/2020 72 Years War or Dates 1967-1969 F Place of Death Hospital,Institution or WCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title Edit Masaba MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 16 ❑Burial Date Cemetery,Crematory or Facility Name 04/29/2020 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York ❑Donation z Removal Date Place Removed and/or and/or Held N Hold Address O n. Date Point of V) Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment 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 Remains are Shipped,If Other than Above Address a W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/29/2020 Registrar of Vital Statistics Shelley.91lckernon(ECectronicallySigned) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: j Z Date of Disposition Ll--L9— Z o 4) Place of Disposition W (address) 2 W N (sedion) (tot number/ (grave number) Name of Sexton or Persoj�in ar of Premises ✓ t a yl 6`r4 !f.��`� 0lease print) W Signature Title /V M DOH-1555(o7/18)p 1,,'gf 2 Public Health Law Sec. 4145(2b) J 13 6 5 q Receipt w Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#,