Arsenault, Thomas Arthur NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thomas Arthur Arsenault Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/05/2022 62 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Greenfield Town Street Address 596 Spier Falls Road,Greenfield Town,New York 12833
p Manner of Death
Natural Cause Accident Homicide Suicide Undetermined ❑Pending
UCircumstances Investigation
WC3 Medical Certifier Name Title
Jennifer Hayes MD
Address
200 Smith Drive,Corinth,New York 12822
Death Certificate Filed Town Of Greenfield District Number Register Number
City,Town or Village 4557 19
X Burial Date Cemetery,Crematory or Facility Name
06/08/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
U)ETransportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment 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 Other than Above
2 Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/07/2022 Registrar of Vital Statistics Louise Okoniewski(ECectmnicaCCySigned)
(signature)
District Number 4557 Place Town Of Greenfield
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I- ,, I
Z Date of Disposition 6. 8 . a a Place of Disposition / (uoKeQ tom• a(deer)s,bCJ rL! /y /o)S64
l 6�(address)
UWU) Ri fir) ! 1
CC (section)z (lot number) (grave number)
0 Name of Sexto r Person in Charge of Premises / GY)n;e (ZeC1eQT
(please print)t)
W Signature �J�(X UkLr C� l Title
n �enCJ�'r7t
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
012922
Receipt
Human remains of 4 , delivered on - . , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
1(.75
Lot No. 11-I
Address 52 Lamplighter Acres , Fort Edward NY 12828 Section No.
Owner MaryJane Yanklowitz Plot Horicon
Date 8/17/04
Approx. 67 Superficial ft.
Location Bounded on North by Weinberg, South by Vacant , East by Shepard,
West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 3312
Payment Record Paid in Full 8/17/04 )$1 ,000.00)
Record of Interments
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Form No. 01
•
ARSENAULT
NAME Thomas Arthur Arsenault Age: 62
Lot Owner: MaryJane Yanklowitz
Lot# Horicon 1 I Grave# 2
Case: Concrete
Died: 6,5,2 2 Interred: 6.8.22
Funeral Home: Regan Denny Stafford FH
Cemetery: Pine View