Walkup, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
O` Name First Middle Last Sex
Joseph T{,o mos Walkup Male
': Date of Death Age If Veteran of U.S. Armed Forces,
December 15, 2018 80 War or Dates
- Place of Death Hospital, Institution or
in City, Town or Village Fort Edward Street Address 514 Hinds Road
W. Manner of Death Eul7TINatural Cause 0 Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
„ Circumstances Investigation
W Medical Certifier Name Title
Philip J Gara Jr. MD,
Address
327 Broadway Fort Edward, NY 12828
Death Certificate Filed District Number S Register Number
City, Town or Village .9?
El Burial Date Cemetery or Crematory
*. December 1%, 2018 Pine View Crematorium
❑Entombment Address
4,®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
Hold Pine View Crematorium
N Date Point of
IL' 0 Transportation Shipment
by Common Destination
41111.1,
0 Carrier
0 Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
, Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
2" Address
CC
U"' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued is* 4 I g Registrar of Vital Statistics
(signature)
District Number 5 7 5 o Place CAqv( ►J1�
c
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uk Date of Disposition 12/17/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
LLh
ii09
IZ (section) (lot number) (grave number)
gName of Sexton or Person in Charge of Premises t .`I`«i �(..,.<at
(please print)
W` Signature p A-- Title Cite` c- f-
(over)
DOH-1555 (02/2004)