Dimick, Arthur NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arthur E. Dimick M
Date of Death Age If Veteran of U.S. Armed Forces,
8-31-97 76 War or Dates WW II
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address GFH
Manner of Death R Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0. Martelo _ MD
Address
Glens Falls, NY _
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601
Date Cemetery or Crematory
❑Burial 9-4-97 Pine View Crematory
Address
®Cremation Queensbury, NY
Date Place Removed
8❑Removal and/or Held
-: and/or Address
a Hold
0 Date Point of
NQ Transportation I Shipment _
by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker FH 00018
Address
Warrensburg,NY
Name of Funeral Firm Making Disposition or to Whom
N. Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 9-3-97 Registrar of Vital Statistics
(signature)
District Number 5601 Place City of 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 q{�-9� Place of Disposition
2 (address)
UJI
(section) (lot numbe ) (grave number)
0 Name of Sext or Person in Charge of remises .�Vk f 41?D ���
z - (please pant) _ f
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61