Arno, David NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit rermit
N• ame First Middle Last Sex
tsi
„ David H. Arno Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 6, 2014 72 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause ElAccident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
'. Scott Biasetti, M.D. Dr.
Address
100 Park Street Glens Falls, NY 12801
h Certificate Filed District Number Register Number
`, City,'Town or Village j 1 r,• 1---a-k IS c 610 / 61
❑Burial Date Cemetery or Crematory
February 7, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Hold Address
Date Point of
mow- ❑
` Transportation Shipment
`t by Common Destination
ia Carrier
0 Date Cemetery Address
Yx ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
N• ame of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
_- I Address
Permission is hereby granted to dispose of the human remains described above as indicated.
teg Date Issued 2-) -7 / 1. L) Registrar of Vital Statistics UJ o w
(signa re)
District Number 5 b c, 1 Place C W� VG1 t l s / NI Y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tit D• ate of Disposition 02/07/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
It
(section) (lot number) (grave number)
N• ame of Sexton or Persortin Charge of remises dtts-ifficr
sii
( ease print)
Signature , Title calorie
(over)
DOH-1555 (02/2004)