Eggleston, William James NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William James Eggleston Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2020 58 Years War or Dates
F.. Place of Death Hospital,Institution or
W City,Town or Village Hudson Falls Village Street Address 66 Notre Dame Street,Hudson Falls Village,New York 12839
W Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
C.)
W Medical Certifier Name Title
Thomas Kandora MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls Village 5726 13
❑Burial Date Cemetery,Crematory or Facility Name
05/18/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
Donation
0 ❑Removal Date Place Removed
and/or and/or Held
Q) Hold Address
f�
O
IL Date Point of
0 ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
EjReinterment Date Cemetery Address
R
Permit Issued to egistration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
Ix
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/18/2020 Registrar of Vital Statistics Cyntlrtaf7BarJin(! ktronicafStoned,
(signature)
District Number 5726 Place Hudson Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
W
,,_..
Date of Disposition Silf JZ0 Place of Disposition Ltv,
Uj (address)
W
(section) (lotnu�ber/ (grave number)
Name of Sexton or Person in Ch of Premises I
(PPlea print) /
W Signature Title c
DOH-1555(07/18)p 1 of 2
S
Public Health Law Sec. 4145(2b) J -3 8 4
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#