Tamvada, Anvind NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Arvind Tamvada Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/13/2022 41 Years War or Dates
F... Place of Death Hospital,Institution or
Z City,Town or Village Hudson Falls Village Street Address 22 North Oak Street,Hudson Falls Village,New York 12839
LIJ
p Manner of Death El Natural Cause ❑Accident Homicide ESuicide Undetermined Pending
ttt
O Circumstances Investigation
WW Medical Certifier Name Title
CI John Aiken Coroner
Address
40 Burquist Road,Fort Ann Town,New York 12827
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 14
s Burial Date Cemetery,Crematory or Facility Name
03/18/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
DDonation
ZZ• Removal Date Place Removed
and/or and/or Held
.— Hold Address
CO
d Date Point of
N ElTransportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
EiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
f- Remains are Shipped,If Other than Above
2 Address
Ir
W
Q' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/17/2022 Registrar of Vital Statistics Cynthia Bardin(E(ectronicalfySigned)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F �
W Date of Disposition 3 l /q?'?d 4ace of Disposition '"Jt v;e� Cr-`,pi j4o
2 (address) /
W
N
CC (section) , (lot number/ (grave number)
A'1/
g Name of Sexton or Person in Charge o remises F 11.40 J 1b i( ()C0
Z (p!ddse print)
W Signature ���i� hip-�/1r `i0
g �J Title �IQ e q
DOH-1555(07/18)p 1 of 2 / V
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pt1 170 .)
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#