Thiess, Walter 2Z7
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Walter Thiess Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/21/2021 89 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Et Natural Cause 1:1Accident Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
U
0 Medical Certifier Name Title
Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 111
Burial Date Cemetery,Crematory or Facility Name
02/24/2021 Pine View Crematory
El Entombment Address
ElCremation Queensbury Town,New York
ElDonation
OZ Removal Date Place Removed
and/or and/or Held
N Hold Address
O
O. Date Point of
Cl) 11 Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i.. Remains are Shipped,If Other than Above
g Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/23/2021 Registrar of Vital Statistics 9p6ertf7ndrewCurtuglectronicaf 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:
g_
Z Date of Disposition 3 IZ , 71 Place of Disposition l ‘24 ,
W
2 (address)
W
N
Q (section) of number) (grave number)
0 Name of Sexton or Person in Charge of Premises is Jf`h
Z (pleas prin7
W Signature l Title lllf4"41
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#