Schwab Jr., Arthur Thomas *it IC
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Arthur Thomas Schwab Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/22/2021 84 Years War or Dates 1957-1959
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
p Manner of Death 0 Natural Cause ❑Accident ❑ Homicide ElSuicide Ej Undetermined Pending
UJ
U Circumstances Investigation
0 Medical Certifier Name Title
William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 622
Burial Date Cemetery,Crematory or Facility Name
12/23/2021 Pine View Crematory
❑Entombment Address
EiCremation Queensbury Town,New York
❑ Donation
Removal Date Place Removed
and/or and/or Held
H Hold Address
0
EL Date Point of
NL j Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
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
F- Remains are Shipped,If Other than Above
M Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/23/2021 Registrar of Vital Statistics a2o6ert/7ndraw Curtis(Electronica!lySigned)
(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:
IF-
Z Date of Disposition fL 27 Za ( Place of Disposition 7 I * J,fJ (r 't k
(addressy
W
CC CC (section) (lot n�er) (grave number)
0 Name of Sexton or Person in Charge of Pre ses I�y1 j'M(. )l L�'Off
Z (please print)
W Signature �� ��" TitleL),. 12'c
g
DOH-1555(07/18)p 1 of 2
1 _ 5 4 gz5
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# '