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Nokes, Arthur Wesley r 1331 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Arthur Wesley Nokes Male Date of Death Age If Veteran of U.S.Armed Forces, 12/21/2020 84 Years War or Dates 1968-74 I_ Place of Death Hospital,Institution or Z City,Town or Village South Glens Falls Village Street Address 11 Woodcrest Drive,South Glens Falls Village,New York 12803 W Manner of Death Undetermined 0 Pending 0 © Natural Cause �Accident �Homicide �Suicide W U Circumstances Investigation W Medical Certifier Name Title C Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 17 Burial Date Cemetery,Crematory or Facility Name 12/23/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York a Donation Z Removal Date Place Removed and/or and/or Held f- Hold Address N 0 Date Point of (/) I=1 Transportation Shipment p by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address Ce LU a" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/22/2020 Registrar of Vital Statistics Shannon Kelleher(EfectronicaffySigned) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z' Date of Disposition t'Z=Z3--ZLi/t.'Place of Disposition 7 ,>1Q u ,secj G.t mall W (address) W Cl) (section) (lot number) (grave number) LEI ▪ Name of Sexton or Pe n i harge of Premises .i v / 1 rl 64 r✓ia✓h e (please print) W l/Signature r Title C' ''1 a)111f/ orcv,14,-- � DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 14 3 21 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#