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Paddock Jr., Walter A
13IV NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Walter A Paddock Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 12/15/2020 91 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Greenfield Town Street Address 4400 Route 9 N Route,Greenfield Town,New York 12859 p Manner of Death © Natural Cause El Accident Homicide ❑Suicide Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title 0 Amy Johnson PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Greenfield Center 4557 26 ElBurial Date Cemetery,Crematory or Facility Name 12/17/2020 Pineview Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed Q and/or and/or Held Hold Address CO O O. Date Point of (0 ❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/16/2020 Registrar of Vital Statistics Louise Okoniewski(Electronically Signed) (signature) District Number 4557 Place Greenfield Center, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition / -,7-2azO Place of Disposition 7`` 1 e ✓e i'I t 4 4'i' 2 (a ress) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Ch a of Pre ses h'/rI/drJ C (,t�bC� l (please print) W Signature /� Title 1 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1. ,3 C O Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#