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Arnold, William Harold 11
ID`411 NEW YORK STATE DEPARTMENT OF HEALTH ([ )F Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Harold Arnold II Male Date of Death Age If Veteran of U.S.Armed Forces, 12/25/2023 41 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Thurman Town Street Address 23 Huber Road,Thurman Town, New York 12885 W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Thurman District Number Register Number City,Town or Village 5659 9 Burial Date Cemetery,Crematory or Facility Name 12/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of (/)El Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment EI Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom 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 12/27/2023 Registrar of Vital Statistics Cynthia R;Jfyde(ECectronicalry Signed) (signature) District Number 5659 Place Town Of Thurman I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition /`Z Lt 2dP3 Place of Disposition PI.Aie L'e Cart wrj W 2 (address) 11J CC CC (section) (lot number) (grave number) 11 Name of Sexton or Person in Charge of P mise j'�e41 '� i.J (p/ease print) W Signature Title ,o5"R- 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#