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Stone, Willard J. 2H� NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Willard J.Stone Male Date of Death Age If Veteran of U.S.Armed Forces, 03/20/2020 84 Years War or Dates Korean Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Daughters Of Sarah Nursing Center Uj p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Isabel Mendoza NP Address 180 Washington Ext Ave,Albany, New York 12203 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0625 ❑Burial Date Cemetery,Crematory or Facility Name 03/20/2020 Pine View Crematory Entombment Address RICremation Queensbury Town,New York ❑Donation ZZ -T Removal Date Place Removed and/or and/or Held H Hold Address fR O IL Date Point of N ❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Otherthan Above M Address M W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/20/2020 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition Place of Disposition R,j c �/,` � rwle t! Uj (addres W N (section) (lot number/ (grave number) Q • ' 0 Name of Sexton or Person in Ch ge of Premi s a Ge�D (please print/Z W Signature Title r DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b)w - 013443 Receipt Human remains of i "t ' `� ' delivered on ..1 , 2Q Pixie View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#