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Appling, William NEW YORK STATE DEPARTMENT OF HEALTH f s # yit Vital Records Section Burial - Transit Permit Name First Middle Last Sex William Howard Appling Male Date of Death 7 Age If Veteran of U.S. Armed Forces, May 25, 201 86 War or Dates Korea Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ILL]Natural Cause El Accident El Homicide ❑ Suicide Q Undetermined ❑ Pending UJ Circumstances Investigation W Medical Certifier Name Title 0 Dean Reali, M.D Address Hudson Headwaters Warrensburg, NY 12885 Death Certificate Filed District Number Register u ber City, Town or Village 5601 C_ ❑Burial Date Cemetery or Crematory May 30, 2017 Pine View Crematorium ❑Entombment Address ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held 0and/or Address p Hold Pine View Crematorium 021 Date Point of a.▪ ❑Transportation Shipment 0) by Common Destination O Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number -` Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I Remains are Shipped, If Other than Above • Address IX_ al`s d' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued cj ) �C� 1 Registrar of Vital Statistics .,/Q W.,/•-A-V.XT ,:,' (signature) b District Number 5601 Place 6 csuv.SRA. \\ S u " I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 05/30/2017 Place of Disposition Quaker Road Queensbury,NY 12804 M. (address) all G? ©° (section) /� (lot number) ( (grave number) O Name of Sexton or Person in Charge of P emises L Zp,l ' e r Sbut llt z �t� (phase print) W Signature �` Title (owl (over) DOH-1555 (02/2004)