Nelson Jr, Arnold NEW YORK STATE DEPARTMENT OF HEALTH r
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arnold G. Nelson,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 26,2016 74 War or Dates 61-64
Place of Death Hospital, Institution or
Z' City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide n Undetermined Pending
in Circumstances Investigation
iu• Medical Certifier Name Title
Howard E. Silverberg
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Regicber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
November 28,2016 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
F' Hold
Cl)
O Date Point of
O.
• Transportation Shipment
a by Common Destination
Carrier
Li Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I= Remains are Shipped, If Other than Above
X Address
Ct
Q. Permission is here: granted to dispose of the human emains described• bove as i, i ted.
Date Issued (( FARi
�U�(o Registrar of Vital Statistics CI_,(;p
(signature)
District Number , ---/0 > i Place 7 C__J�
. I
I certify that the remains of the decedent identified above w e disposed of in accordance wi//h this permit on:
iti• Date of Disposition 1112gJIb Place of Disposition f ftJitM Ct; ateYl 1
2 (address)
CO
O (section) A (lot number) (grave number)
pName of Sexton or Person in Charge of Premises /AfA r 3041t'Lf
`Z r (phase print)
Signature et y' r Title air MOM
(over)
DOH-1555 (02/2004)