Bayard, William NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William John Bayard Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 3,2018 45 War or Dates n/a
Place of Death Hospital, Institution or
$ City, Town or Village Warrensburg,NY Street Address 11D Swan Street
! Manner of Death Natural Cause ❑Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
w Medical Certifier Name Title
0 Terry Comeau.Coroner
Address
Lake George,NY
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg,NY
❑Burial Date Cemetery or Crematory
Entombment January 8,2018 Pine View Crematory
Address
®Cremation Queensbury,NY
Date Place Removed
ZZ n Removal and/or Held
2 and/or Address
H Ho cold
O Date Point of
N n Transportation Shipment
p by Common Destination
Carrier _
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i.* Remains are Shipped, If Other than Above
Address
Ili
Permission is here y granted to dispose of the human_ ins des filled above as indicated.
- u/
Date Issued i/� V Registrar of Vital Statistics (/Gu
(signature)
District Number 07,(0 Place /Liflj4A,e_e44. i /
I certify that the remains of the decedent identified above w disposed of in accordance with this permit on:
Z
iiii Date of Disposition ////43 Place of Disposition ,Y1e v i 6,,,,1 G.`2m4. ry
W (addres )
co
re (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises -. L. /,`er,y 6(4,e/ILar-1,•c
W ,k �' (please print)
Signature Title 6-,e me. ''
(over)
DOH-1555(02/2004)