Davis, Sr. Arthur NEW YORK STATE DEPARTMENT OF HEALTH 14 -2.-'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arthur J. Davis, Sr Male
Date of Death 1 Age If Veteran of U.S. Armed Forces,
March 12, 2011 85 War or Dates
f_ Place of Death Hospital, Institution or
.Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
:c3 Manner of Death X Natural Cause I l Accident Homicide Suicide Undetermined Pending
Au Circumstances Investigation
t Medical Certifier Name Title
0 Mathew Varughese,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 03-
0 Burial Date Cemetery or Crematory
March 16, 2011 1 Pine View Crematory
❑Entombment Address
❑x Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
2 and/or Address
H Hold
N
0 Date Point of
u) Transportation , Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
k(P. Remains are Shipped, If Other than Above
2 Address
to
CA` Permission is hereby granted to dispose of the human remains descr'b d ov s in c t .
Date Issued 03//Zp// Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3-2 I-II Place of Disposition t Vi tu„) £ c¢,rw._
W (address)
CO
CL (section) . (lof number) (grave number)
pName of Sexton or Person in Charge of Premises ( h r,5 IILr a 4
'Z lease print)
Signature Title ei2YNi yoUit-
(over)
DOH-1555(02/2004)