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Walling, Joseph NEW YORK STATE DEPARTMENT OF HEALTH 1 bg. Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joseph D Walling Male Date of Death Age If Veteran of U.S. Armed Forces, January 20, 2016 73 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Fri I ifi Natural Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation I Medical Certifier Name Title Philip J. Gara, Dr. Address 318 Broadway Fort Edward 12828 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5a j1 - ❑Burial Date Cemetery or Crematory January 21, 2016 Pine View Crematory <❑Entombment Address ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier '� Disinterment Date Cemetery Address =- El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 _ Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is herb granted to dispose of the human(emains scribed ove as in%mate.. Date Issued ©/4 „O/� Registrar of Vital S i ics 61�.e��� ` �)`` p (signature) District Number Place F. —,Z I certify that the remains of the decedent identified above were disposed of in accordance with is permit on: Date of Disposition 01/21/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) I (section) (lot number (grave number) 0 Name of Sexton or Person in Char a of Premises41 �r:yt�ola-- e�{M �n� (pldase print) W. Signature ��.( Title liZ li)1 . 9 (over) DOH-1555 (02/2004)