Wells, Noah Sr. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Noah Wells Sr Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/04/2022 82 Years War or Dates
i_ Place of Death Hospital,Institution or
ZCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Mannerof Death El Natural Cause DAcci ElHomicide ❑Suicide Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Joshua Starters NP
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
E
Cit ,Town or Village 5750 6
Burial Date Cemetery,Crematory or Facility Name 03/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
0 DRemoval Date Place Removed
p and/or and/or Held
N Hold Address
0
a. Date Point of
fA DTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
D Re interment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Otherthan Above
M Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/07/2022 Registrar of Vital Statistics S# ilyAic n(ElictronicallySiznsa)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 3-9-2t?22 Place of Disposition me,LI;C�.� firL rnrz4..-
D (address)
W
U)
Fr (section) (lot numbed (grave number)
SName of Sexton or Perso 'n Cha e of Premises �L;/t a"h &✓vt Q C,,4t'
Z (please print) /
W Signature Zv Title e-- 'it.- ''yr" >�i"-'+ C�
DOH 1555(07/18)p f 2 l
r ,
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# i�''