Ringer, Arthur Thomas x #5sl
NEWYORKSTATEDEPARTMENTOFHEALTH -``°�----•�
Bureau of Vital Records Burial- Transit Permit
Name First Middle Last Sex
Arthur Thomas Ringer Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/21/2022 57 Years Waror Dates
Place of Death Hospital,Institution or
City,Town or Village Waterford Town Street Address 83 Hudson River Road 107,Waterford Town.New York 12188
3. Manner of Death E:i Natural Cause Accident El Homicide Suicide Undetermined gaPending
W Circumstances Investigation
WMedical Certifier Name Title
G David DeCeNe Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed Town Of Waterford District Number Register Number
Cit ,Town or Village 4588 28
Burial Date Cemetery,Crematory or Facility Name
10/26/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
Removal Date Place Removed
F and/or and/or Held
H Hold Address
Date Point of
Transportation Shipment
by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Khmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
rS Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/24/2022 Registrar of Vital Statistics Lynda,?Boato d,Dnical&Sf9
(signature/
District Number 4588 Place Town Of Waterford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition I O I2iP I Z t Place of Disposition ` AL,
4.........._
2 (address
W
CE (section) A (tot nu ber/ (gra►ae number)
8 Name of Sexton or Person in a of Premises °1�
Ase print/ /'
IllSignature Title ` �
DOH 1555(07/t8)p i of 2
Public Health Law Sec. 4145(2b) 111
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named,on burial permit
Official Funeral Directors Reg.or License#