Bishop, William NEW YORK STATE DEPARTMENT OF HEALTH t 1T f€37-t�
Vital Records Section Burial - Transit Permit-J
Name First Middle Last
William Scott Sex
Date of Death Bishop Male
Age If Veteran of U.S. Armed Forces,
September 1, 2017 41 War or Dates n/a
ZPlace of Death Hospital, Institution or
pCity, Town or Village Queensbury, NY Street Address 31 Margaret Drive
Manner of Death
lit
XI Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
0 Circumstances Investigation
ui Medical Certifier Name Title
Q Paul Bachman,MD—Coroner
Address
Main Street,Warrensburg„NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury, NY 5657 i j \
❑Burial Date Cemetery or Crematory
September 5, 2017 Pine View Crematorium
❑Entombment Address
i Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
H Hold
Cl)
0 Date Point of
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Date CemeteryAddress
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
IZ
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued R- S -�O 11 Registrar of Vital Statistics ---(2,,A.i. -.-lhx.e :A
(signature)
District Number 5 V Place Q u ✓1 Ioj J/t!
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition Q li
11l Place of Disposition eist ( „�(„„
W (address)
Ce
0 (section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Pre ises hP,,rt —itiq t-
Wrah (plea a print)
Signature diA Title ac MI v10.'1,
(over)
DOH-1555(02/2004)
4