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Dixon, William t .1 NEW YORK STATE DEPARTMENT OF HEALTH Vitt Records Section Burial - Transit Permit Name First Middle Last Sex Ma William Homer Dixon le Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2018 81 Years War or Dates 1959-62 t- Place of Death Hospital, Institution or Z City, Town or Visage Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident [J Homicide El Suicide ❑Undetermined n Pending Circumstances Investigation W Medical Certifier Name Title a William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 553 °Burial Date Cemetery or Crematory 11/27/2018 Pine View Crematory []Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held and/or Address • Hold LC n. Date ( Point of to,[]Transportation I Shipment i by Common Destination Carrier Disinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom t. Remains are Shipped, If Other than Above Address 1U - Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/26/2018 Registrar of Vital Statistics 24,6ert,1 Curtis Octronicatfy Signed) (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: f Date of Disposition I c 1-t' Place of Disposition i ;,vt, C,Utor vetf cry (address) Ett Eta (section) (lot number) (grVe number) 0• Name of Sexton or Person in Charge of Premises t1 t,,C rrue,y ?sui S (Please Pall) till Signature Title s ftrtiq t (over) DOH-1555(02/2004)