Sherwood, Arthur Clarence Jr. (.___
` ,CO
—
NEW YORKSTATE DEPARTMENTOF HEALTHBurial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Arthur Clarence Sherwood Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/02/2022 82 Years War or Dates
F, Place of Death Hospital,Institution or
Z
City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death El Natural Cause Accident 0 Homicide Suicide Fpndetermined ❑Pending
W Circumstances Investigation
C.) Medical Certifier Name Title
CI William Cleaver 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 601
Burial Date Cemetery,Crematory or Facility Name
12/05/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Removal and/or Date Place Removed
off and/or Held
H Hold Address
N
0
Date Point of
(I)❑Transportation Shipment
p by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
Date Cemetery Address
❑Reinterment
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
H Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/04/2022 Registrar of Vital Statistics Megan No(in(E(ectronica((y 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
W Date of Disposition j 2 IC-177 Place of Disposition mi l' tN. ��
(address)
W
CC (section) /loU�umber/ _C (grave number)
0 Name of Sexton or Person in Charge- -Premises / r \, -\�'hn��
0 /pp ase print/
Z ivic�,Hfoe
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) j1 a15 .6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#