Williamson, Sidney NEW YORK STATE DEPARTMENT OF HEALTH Z,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sidney Williamson Male
Date of Death Age If Viteran of U.S. Armed Forces,
1- June 7, 2006 �� War or Dates
z Place of Death Hospital, Institution or
W City, Town, or Village GLENS FALLa Street AddressGLENs FALLS HOSPITAL
G Manner of Death`rrNatural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ❑ Pending
W �`�� Circumstances Investigation
WMedical Certifier� ame v T
/G 4-P )G �7 .
0 pirevo .2cr�' /4 cry _ �Y / /oe
Death Certificate Fil 'strict Number, Register umber
'1 City, Town or Village GLENS FALLS (5�0/ d 7.3
Date Cemetery or Crematory
❑ Burial June 14, 2006 PINE VIEW CREMATORY
Address
®Cremation QUAKER RD OUEENSBURY, NY 12804
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 0 Transportation Shipment
, by Common Destination
i Carrier
h ❑ Disinterment
Date Cemetery Address
Y Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00135
Address
9 Pine St. / P.O. Box 455, Chestertown, New York 12817
t Name of Funeral Firm Making Disposition or to Whom
a Remains are Shipped, If Other than Above
EAddress
Permission is her gr ted to dispose of the human remains des ynbG oy�as i ted.
Date Issued Registrar of Vital Statistics iL ;
(signature)
District Number( ��pp f Place GLENS FALLS,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition le-/5-6le Place of Disposition /7, 1I E 4 4f l.Ui G i .E.-44 *O I 0.'`7
g (address)
W
Id
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises (i i4P), ���0
W (please prim
Signature Title CAR 4