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Hewitt, Arthur A.
JrIti0 NEW YORK STATE DEPARTMENT OF HEALTH . Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Arthur A.Hewitt Male Date of Death Age If Veteran of U.S.Armed Forces, 12/08/2020 86 Years War or Dates Army Reserve Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause Accident EI Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation Q Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 557 Burial Date Cemetery,Crematory or Facility Name 12/09/2020 Pineview Crematorium ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H N Hold Address 0 O. Date Point of CO ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/09/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition iZIS I t Place of Disposition 2 (address W N (section) Jot number/ (grave number) O Name of Sexton or Person in Char of Premises P fLPhAT Z (plea print1 W Signature Title Co 't11�'j DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 8 Receipt Human remains of delivered on , , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#