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Nelson, Peter Walter
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peter Walter Nelson Male Date of Death Age If Veteran of U.S.Armed Forces, 03/23/2023 85 Years War or Dates 1961-1963 H Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 34 Prospect Drive,Queensbury Town, New York 12804 p Manner of Death Z Natural Cause Accident 0 Homicide ESuicide Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title 0 Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 40 Burial Date Cemetery,Crematory or Facility Name 03/24/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 Q. Date Point of t/)ETransportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom l— 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 03/24/2023 Registrar of Vital Statistics Caroline 7fi(fegarde Barber(E(ectronicatTySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I I W Date of Disposition 31 Pi I Z Place of Disposition [v (address) 2 W CCCC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises �-- It Z /� - (p ease print) W Signature Cf y Title �L�rrnlH�Zr� 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#