Meehan, William e
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
K Name First Middle Last Sex
William F. Meehan Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 12, 2014 57 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
14.1 Circumstances Investigation
Medical Certifier Name Title
El Gary Scidmore
Ej : Address
:•::. 6920 State Route 8,Brant Lake,NY 12815
ir. Death Certificate Filed District Number Register Number
▪. City, Town or Village Glens Falls 5601 3 32
❑X Burial Date Cemetery or Crematory
July 15, 2014 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, ,NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
F Hold
co
O Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date I Cemetery Address
Reinterment Date Cemetery Address
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
Address
▪ Permission is hereb granted to dispose of the human remains ddab ve s i i d.
t.• descri
��::: Date Issued a?�/(249"y Registrar of Vital Statistics
::'..: (signature)
• District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 7/1 5/1 4 Pine View Cemetery
W Date of Disposition Place of Disposition
W (address)
N Erie 25 B 1
C4 (section) (lot number) (grave number)
Q Name of Se n or Person in Charge of Premises Connie L. Goedert
Z ( lease print
W j? d ( Superinenden
Signature / - r-- Title
(over)
DOH-1555(02/2004)