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Graham, Arnold Edward (It log NEW YORKSTATE DEPARTMENT OF HEALTH ..s. Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Arnold Edward Graham Male Date of Death Age If Veteran of U.S.Armed Forces, 12/04/2021 74 Years War or Dates F,. Place of Death Hospital,Institution or W City,Town or Village Argyle Town Street Address 610 Coot Hill Road,Argyle Town,New York 12809 p Manner of Death EI Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ©Pending W Circumstances Investigation W• Medical Certifier Name Title O Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Ni Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 73 ElBurial Date Cemetery,Crematory or Facility Name 12/07/2021 Pine View Crematory ElEntombment Address ElCremation Queensbury Town,New York Donation z Date Place Removed Removal and/or Held H and/or N Hold Address 0 Date Point of t/) 11 Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ElDisinterment El Reinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above " Address cr W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2021 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: I— W2U Date of Disposition /Z-7- Zl Place of Disposition P/�ye v 7 ) G (address)h/ 2 W N (section) lot number) (grave number) cc SName of Sexton or P on i Charge of Premises jW`1 4"1.1'4 Z (please print) tL Signature Title G rUD/y ;� DOH-1555(07/18)p 1 of 2 I 1 1 Public Health Law Sec. 4145(2b) 015414 1 1 1 Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#