Flewelling Jr, Joseph NEW YORK STATE DEPARTMENT OF HEALTH f ^- W 6Slo
Vital Records Section ,_. _. Burial - Transit Permit
4 Name First Middle Last Sex
Joseph Lewis Flewelling Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
September 6, 2015 80 War or Dates
'°. Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address 606 Pleasant Valley Road
Manner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
; Circumstances Investigation
, Medical Certifier Name Title
John Mongan, Dr.
Address
6 Medical Park Ballston Spa, NY 12020
" Death Certificate Filed District Number Register Number
MIL City, Town or Village Argyle Si 5 41.6
"iii
0 Burial Date / Cemetery or Crematory
tO Z0�> 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
Date Cemetery Address
' . ❑ Disinterment
a- Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
V Address
0.3.: Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued cj) Q) 15 Registrar of Vital Statistics Skp�` c. ,t,^.o,
�
(signature)
pa District Number S7S10 Place ti )4 thc)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�''- Date of Disposition 1/lI16T Place of Disposition 21Quaker Road Queensbury,NY 12804
(address)
,
e (section) (lot number) (grave number)
>y Name of Sexton or Pers n in Charge f Premises ' _, SL44"1t
(pl ase print)
rim g: ' Signature Title
.°
(over)
DOH-1555 (02/2004)