Scott, Harold Donald 30S
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Harold Donald Scott Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/24/2021 85 Years War or Dates 1957-1960
I— Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 4677 County Route 48,Argyle Town, New York 12809
ILI
p Manner of Death 0 Natural Cause 0 Accident Homicide Ei Suicide 0 Undetermined ❑Pending
W U Circumstances Investigation
W Medical Certifier Name Title
CI Robert Nielson MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 24
0 Burial Date Cemetery,Crematory or Facility Name
03/26/2021 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
0 Donation
Date Place Removed
Removal and/or Held
F- and/or
N
Hold Address
0
Date Point of
Cl) L j Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
0 Disinterment
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/26/2021 Registrar of Vital Statistics She&yAlckernon(EYectron callySignea9
(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:
I—
Z Date of Disposition 3/26(2( Place of Disposition ..,,( ci..—.
W (address)
W
CD
CC (section) (tot number . (grave number)
0
Name of Sexton or Person in Charge of Pr ises �" r'' � m4r��
Q /,ase print)
z 7i24rlf(t
W Signature Title
DOH-1555(07/18)p 1 of 2
r.
Public Health Law Sec. 4145(2b) 01 4 6 71..
Receipt
t ' f i
Human remains of '•( delivered on \"` , 20 `l i'
S
Pine View Cemetery Representing the funeral home named on buriAlgeynit
Official Funeral Directors Reg.or License# ,?,' '; f