Congdon II, William NEW YORK STATE DEPARTMENT OF-HEALTH �t
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Eddy Congdon ii Male
Date of Death Age If Veteran of U.S. Armed Forces,
08/04/2017 85 Years War or Dates Air Force
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause 0 Accident El Homicide O Suicide Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Mark Quaresima MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 420
❑Burial Date Cemetery or Crematory
08/07/2017 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
ri Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/04/2017 Registrar of Vital Statistics 106ertACurtis Ekctranicaays>gned
(signature)
District Number s01 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition f/3) J Place of Disposition Q�tti,t.,i eirityt y ar_—
(address)
(section) or number) (grave number)
Name of Sexton or Person in Charge of Pre ises �t+ e"'1l/t
(pie a print)
Signature 's Title me
(over)
DOH-1555(02/2004)