Galbraith, Arnold NEW YORK STATE DEPARTMENT OF HEALTH �Z3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arnold W. Galbraith Male
Date of Death Age 1 If Veteran of U.S. Armed Forces,
7/30/2018 93 War or Dates 1945-1947
i.. Place of Death Hospital, Institution or
Z City, Town or Village Town of Dresden I Street Address 3034 Points Of View Lane
ci Manner of Death `^ Natural Cause V ,Accident E Homicide _Suicide Undetermined I I Pending
W Circumstances Investigation
W Medical Certifier Name Title
Q Frances C.Bollinger
Address
161 Carey Rd.,Queensbury,NY 12804
Death Certificate Filed i District Number 1 Register Number
City, Town or Village Town of Dresden
❑Burial Date Cemetery or Crematory
August 1,2018 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date ! Place Removed
ZZ 1 Removal _ v and/or Held _v
and/or Address
F' Hold
N
O Date Point of
u) [^Transportation Shipment
p by Common Destination
Carrier
—
Disinterment Date Cemetery Address
ri Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
l— Remains are Shipped, If Other than Above
2 Address
IX'
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued (3'-0I--2o18" Registrar of Vital Statistics _)AZL 4
+�-�// n/ �/ (signature) q
District Number 575 2_ Place / /-.-i 1 li a t&c W� l,/otJ'�'jf ls' 11r Y / .2?"/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z W Date of Disposition 11.3111 nA l($ Place of Disposition t% -- sL'tr-r.
g (address)
W
CO
CL
(section) (I !numb r} (C (grave number)
pName of Sexton or Person in Char a of Premises �A�� MAit
Z b (pleas pant)
WfiIt
Signature Title
(over)
DOH-1555(02/2004)