Mahon, William NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Patrick Mahon Male
Date of Death Age If Veteran of U.S. Armed Forces,
ig 8/19/1998 78 War or Dates WWII
Place of Death Hospital, Institution or
City, Town or Village Argyle I Street Address Route 40
Manner of Death ❑Natural Cause 0 Accident 0 Homicide XD Suicide ❑Undetermined E Pending
Circumstances Investigation
Medical Certifier Name Title
0 B.P. Jensen, MD
Address
6225 Main St. Argyle NY 12809
Death Certificate Filed District Number Register Number
Hi City, Town or Village Argyle, NY _57)50 a3
Date Cemetery or Crematory
❑Burial 8/21/1998 Pine View Crematory
Address
LCremation, Quaker Road Queensbury, New York
Date Place Removed
0❑Removal and/or Held
—• and/or Address
Hold
Date Point of
cn
Q Transportation Shipment
C by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01056
Address
123 Main Street, Argyle NY 12809
4.'"' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
ili Address
W
lii Permission is h reb granted to dispose of the human remains describe
d above as indicated.
Date Issued r I 9 g Registrar of Vital Statistics CA rri it q
(signature)
€ District Number �9 0 0 Place 10.2-2j 0.4,4h,
„:„,i„
I certify that the remains of the decedent identified abo e were disposed of in accordance with this permit on:
f- t
W Date of Disposition 7�MM" Place of Disposition �f A/ vi-,. ici i j , ,4 ."j 76e/J�
(address)
Ui
V)
CC (section) (lot numb r) Jaye number)
flName of Sexton •r Person in Charge of Premises 4 2 ,�Trp m, -,e,
F (please print)
tit Signature •.Ii, Title l
DOH-1555 (10/89) p. 1 of 2 VS-61