Doetch, William 11 2_ pi
...
NEW YORK STATE DEPARTMENT OF HEALTH •
Vital Records Section Burial - Transit Permit
,
Name First Middle Last Sex
William Dean Doetch Male
44 Date of Death Age If Veteran of U.S. Armed Forces,
03f31/2018 88 Years War or Dates
b Place of Death Hospital, Institution or
1 City, Town or Village Glens Falls Street Address Glens Falls Hospital
-.11_11 Manner of Death El Natural Cause El Accident El Homicide 0 Suicide 0 Undetermined ii rl Pending
Circumstances "-I Investigation
,._ Medical Certifier Name Title
..i Astrn Chaudry MD
-
O' Address
100 Park St,Glens Falls,New York 12801
7--.-
-`:is• Death Certificate Filed District Number Register Number
If; i
-- City Town or Village Glens Fails 5601 162
ri
1.....iBurial Date Cemetery or Crematory
04/03/2018 Pine View Crematorium
-,q•pEntombment
Address
0 al Cremation Queensbury Town, New York
Date Place Removed
ot 0 Removal and/or Held
io...„ and/or
--I Address
-.,-, Hold
--irl Date Point of
j r--t
Transportation _ Shipment
by Common Destination
...'-' Carrier
U r__,Disinterment Date Cemetery Address
--....1
njgo
Reinterment
Date Cemetery Address 1
1, Permit Issued to . Registration Number
'11 Name of Funeral Home Carleton Funeral Home Inc 00281
Address
.-....Z.
68 Main Stpo Box 67,Hudson Falls'New York 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
C 1* Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04102/2018 Registrar of Vital Statistics Ro6ert„q Cartt:s.(E&Ironicalry nned)
(signature)
Ar
,..- District Number 5601 Place Glens Falls. New York
41: .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
,-...
Date of Disposition L11311i Place of Disposition
til (address)
70
i7 (section) I. (lorumber)r (grave number)
el
mal Name of Sexton or Person in Charge of Premises n
1.4 ...
444—
U __. ( lease print)
7 Signature Title OM/11Di_
(over)
DOH-1656 (02/2004)