Caprood, Walter Clydess 1F lVV!
—C.NEW YORKSTATE DEPARTMENT OF HEALTHBurial - Transit Permit
Bureau of Vital Records
,,, Name First Middle Last Sex
Walter Clydess Caprood Male
-' Date of Death Age If Veteran of U.S.Armed Forces,
04/03/2022 73 Years War or Dates 1968 to 1971
*' Place of Death Hospital,Institution or
ZCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Q Manner of Death EINatural CauseAccident []Homicide ri Suicide []Undetermined ❑Pending
0 I 'Circumstances Investigation
tl Medical Certifier Name Title
0 Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 196
Burial Date Cemetery,Crematory or Facility Name
04/05/2022 Pine View Crematory
Entombment Address
,,EICremation Queensbury,New York
0Donation
Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
U)[]Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
❑Reinterment
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
(. Remains are Shipped,If Other than Above
2 Address
v.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/05/2022 Registrar of Vital Statistics Megan Wolin(ECectronica1Ty Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
Z Date of Disposition Li 11 I U. Place of Disposition .,ati__ Zr._..,
W
2 (address)
W
CO (section) .floc number) (grave number)
0 Name of Sexton or Person in Charge of Premises A (�� L— "t'�r
t
z .� lease print)
Signature d Title P
DOH-1555(07/18)p 1 of 2
$. ` 3 4
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#