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McEwen, William Martin
NEWYORK STATE DEPARTMENT OF HEALTH y Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Martin McEwen Male Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2020 79 Years War or Dates �. Place of Death W Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Maria Vivenzio DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 39 ❑Burial Date Cemetery,Crematory or Facility Name 01/21/2020 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed Q and/or and/or Held H N Hold Address O IL Date Point of U) ❑Transportation Shipment C] by Common Carrier Destination Disinterment Date Cemetery Address EjReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address l� W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2020 Registrar of Vital Statistics 9ohnPauCFranck(ECectronicaCCySiyned) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Place of Disposition f,.,L 6!�= (address/ W /section/ /lot number/ (grave number/ Name of Sexton or Person in Charge of Pr miser Zg lease print/ 1W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013 2 6 Receipt - Human remains of delivered on , 20 a Pine View Cemetery Representing the funeral home named on burial permit a Official Funeral Directors Reg.or License# 1 i i