Passino, Arthur Millard NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Arthur Millard Passino Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/22/2022 78 Years War or Dates
1— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
IJJ
• Manner of Death ❑X Natural Cause Accident El Homicide El Suicide nUndetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
O Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 491
Burial Date Cemetery,Crematory or Facility Name
10/01/2022 Pine View Crematorium
Entombment Address
ZCremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
CL Date Point of
N Transportation
by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
O
Reinterment
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
Remains are Shipped,If Other than Above
• Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2022 Registrar of Vital Statistics Megan Norin(Etectronica(ry 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:
W
O Date of Disposition / ^ Z A-2UZPlace of Disposition tue U e, i) C/' q?b
2 (address)
LLJ
CC (section) (lot number)! (grave number)
8 Name of Sexton or Person in Char f Pre ises 47 1,r"/ 1-L!
Z (lease print)
W Signature a!�--‘41- 144- Title pees"-^(��
DOH-1555(07/18)p 1 of 2
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#