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Anderson. Walton H.F tit ioszi NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Walton H.F.Anderson Male Date of Death Age If Veteran of U.S.Armed Forces, 12/07/2021 83 Years War or Dates F. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital • Manner of Death © Natural Cause 0 Accident ❑Homicide Suicide Undetermined Pending W Circumstances Investigation 10• Medical Certifier Name Title Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number I Register Number City,Town or Village Glens Falls 5601 J 584 Burial Date Cemetery,Crematory or Facility Name 12/10/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation OZ Removal Date Place Removed H and/or and/or Held Hold Address 0 t/) Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 Remains are Shipped,If Other than Above Address W • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/09/2021 Registrar of Vital Statistics W9bert Andrew Curtis(Electronically 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: W Date of Disposition fZ—/Marl Place of Disposition 1 g e 2 (address) W CC N (section) �� T (tot number) (grave number) 0 Name of Sexton or Person in Cha of Pre ses Or /� GJOO—�J Z AI cease print) WSignature Tf Title ! DOH-1555(o7/18)p 1 of 2 �.. ,,Public Health Law Sec. 4145(2b) Receipt Human remains of ' ' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#