Hastings, Arthur 4 # � (4.
NEW YORK STATE DEPARTMENT OF HEALTH ;i
Vital Records Section Burial - Transit Permit
Name First Arthur Middle Last Hastings Shale
W.
Date of Dead/3 0/1 1 Age 83 If Veteran of U.S. Armed�4 Forces,
r 1 9 41 6
War or Dates
• Place of Death Hospital, Institution or
Albany
7 City, Town orVilla a Street Address Stratton VA Medical Center
iti
Manner of Death Natural Cause El Accident u Homicide El Suicide ri Undetermined ri Pending
W. Circumstances Investigation
ill Medical Certifier Name Lavelle Title MD
Address VAMC 113 Holland Avenue, Albany, NY 12208
Death Certificate Filed Albany District Number1 98 Regis of Number
City, Town or Village
['Burial Date Cemetery or Crematory
Oct. 3, 2011 Pine View Crematory
;:['Entombment Address
;:fCremation Quaker Road, Queensbury, NY 12804 •
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
=7 Hold
Date Point of
Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
1-1
Reinterment Date Cemetery Address
Permit Issued to ileaisergtion Number
Name of Funeral Home Alexander Funeral Home 00035
i> Address
il 3809 Main St . , Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
} Remains are Shipped, If Other than Above
• Address
IP
• Permission is hereby granted to dispose of the human rem describ g !� as ' i ayd.
09/30 f 1 1 es Arri on
Date Issued Registrar of Vital Statistics
[signayture)
1 98 DVAMC 113 Holland Avenue, Alan , N.Y. 1 2208
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IU Date of Disposition ;0-y_t i Place of Disposition ?ie v,`, Cr,ma_cr�u w,r:
(address)
Ili
Cl)
III (section) (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises `�md�-h7 -u mile
2 .�4 (please print)
) Signature J z �►41.4/ /'" Title Ciew,a_te_ ►a__
(over)
DOH-1555 (02/2004)