Townson, William R
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
:ti , Name First Middle Last Sex
William J. Townson,Jr. Male
f Date of Death Age If Veteran of U.S. Armed Forces,
v.: June 17, 2015 61 War or Dates n/a
" Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
r, Manner of Death X Natural Cause I !Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Eric Pillemer,MD
:;:f Address
rrf Glens Falls,NY
Death Certificate Filed District Number Register] um er
i. City, Town or Village Glens Falls, NY 5601 Li
0 Burial Date Cemetery or Crematory
June 23, 2015 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
O Date Point of
NI I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment
Date Cemetery Address
Permit Issued to Registration Number
::r: Name of Funeral Home Regan & Denny Funeral Home 01444
•;0: Address
94 Saratoga Avenue, South Glens Falls,NY 12803
:: Name of Funeral Firm Making Disposition or to Whom
"; Remains are Shipped, If Other than Above
F Address
III
Permission is hereby granted to dispose of the human emains des ibed abov as indicat-d.
Date Issued 6/19/2015 Registrar of Vital Statistics GT e-e- '`7 L l/
(signature)
District Number Q/ Place City of Glens Falls,NY 12 1
I certify that the remains of the decedent identified above were d posed of in accordance with this permit on:
Z
W Date of Disposition 6/23/1 5 Place of Disposition Pine View Cemetery, Queensbury,NY
2 (address)
ILI
Hudson #1 1 1 G 1
CL
O (section) (lot number) (grave number)
p Name of Se n or Person in Charge of Premises Connie L. Goedert
Z I (please print)
W Signature ,�f yl/G� Q {�.j,,,,a,rTitle Cemetery Superintendent
(over)
DOH-1555(02/2004)