Hart, William Joseph NEW YORKSTATE DEPARTMENT OF HEALTH BUriai - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Joseph Hart Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/23/2020 96 Years War or Dates 1942-1946
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town 7Street Address 39 Longview Drive Apt.100,Queensbury Town,New York 12804
W
`p Manner of Death ❑-C Natural Cause Accident FiHomicide Suicide Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
0 Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 51
Burial Date Cemetery,Crematory or Facility Name
03/25/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z ❑Removal Date Place Removed
O and/or and/or Held
H N Hold Address
O
(1. Date Point of
U) ElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
N Remains are Shipped,If Other than Above
g Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/24/2020 Registrar of Vital Statistics Caro neJ92ddegarde Sader(ELe--Monica-5Signed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ �` s
WDate of Disposition �p j Place of Disposition v 0C
� /address/
W
N (section) (lot number) (grave number)
aName of Sexton or Person in C rge of Pre es Y �')
Z C (please print)
tU —71 Signature / Title
DO H-1555(07/18)p 1 of 2
i ,r
Public Health Law Sec. 4145(2b) 01.1 4 0 u f
Receipt
Human remains of >;,,P , , _Y delivered on" , 20
s
Pin(0View Cemetery Repres¢nting the funeral home named on burial permit
Official Funeral Directors Reg.or License#