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Weaver Sr.,Edward J Ar60 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward J Weaver Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 01/15/2021 76 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare Manner of Death Undetermined Pending W ©Natural Cause El Accident 0 Homicide EI Suicide Li Circumstances Investigation W Medical Certifier Name Title 0 Leonard Gelman MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 4 0 Burial Date Cemetery,Crematory or Facility Name 01/19/2021 Pineview Crematory ElEntombment Address ElCremation Queensbury Town,New York El Donation Removal Date Place Removed and/or and/or Held Hold Address N 0 d Date Point of U) U Transportation p by Common Shipment 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 t— Remains are Shipped,If Other than Above 2 Address LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2021 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ � t717"--- Z Date of Disposition �/Zo /Zi Place of Disposition "I '"} (address) W N CC (section) (lot7pmber) - (grave number) 0 Name of Sexton or Person in Charge of Prem. s �yl¢ (please prmtf) W Signature y� Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 14112 6 Receipt Human remains of ' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#