Magowan, William NEW YORK STATE DEPARTMENT OF HEALTHt ���
Vital Records Section Burial - Transit Permit
101
Name First Middle Last Sex
William B Magowan Male
Date of Death Age If Veteran of U.S. Armed Forces,
6/11/2018 86 War or Dates
F. Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 13 Greenwood Lane
pManner of Death I X I Natural Cause ri Accident pi Homicide I Suicide n Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
David Cunningham,MD
Address
3 Irongate Center,Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village c(QS +')
❑Burial Date Cemetery or Crematory
❑Entombment June 13,2018 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
t' Hold
N
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
lReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
E— Remains are Shipped, If Other than Above
2 Address
CC
---
a. Permission is hereby granted� to dispose of the human re ' s described ab Indic d.
Date Issued („p—I2,— 155 Registrar of Vital Statistics aA
/ (signatu
District Number 541:-;1 Place v b u,Q 0 u
I certify that the remains of the decedent identified above ire disposed of in accord. ce with his permit on:
z V
iu w Date of Disposition �jlSlig Place of Disposition
(address)
W
N
(section) (lot,number) (grave number)
pName of Sexton or Person in Charge of Premises AA _...)t,,.t4E1'
Z ( ease print)
Signature Title (R15At1 4:_
(over)
DOH-1555(02/2004)