Williams, George NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George Austin Williams Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/20/2018 93 Years War or Dates wwii
1- Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death X❑Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Stephen Perazzelli MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 452
❑Burial Date Cemetery or Crematory
09/25/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Z ❑Removal and/or Held
t= and/or Address
N Hold
Date Point of
❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration 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
h- Remains are Shipped, If Other than Above
2 Address
rt
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/24/2018 Registrar of Vital Statistics qZ96ertA Curtis(ECectronicaCCySigned)
(signature)
District Number 5601 Place Glens Falls, 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 (1/ 6(tt Place of Disposition i?Q,,,ur,,, C+v,c dri,L.
W (address)
U
(section) (lot number) ` (grave number)
pName of Sexton or Person in Charge o Premises ( j AAA
Z (pl se print)
W Signature Gar4kr Title ag
(over)
DOH-1555 (02/2004)