Bayard, William H NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Howard Bayard Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/09/2018 68 Years War or Dates 69-73
. Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑Natural Cause ❑Accident ❑Homicide E Suicide El❑Undetermined ❑Pending
Circumstances Investigation
'' Medical Certifier Name Title
Sean Bain MD
Address
= 100 Park St,Glens Falls,New York 12801
31 Death Certificate Filed District Number Register Number
k City, Town or Village Glens Falls 5601 227
' ❑Burial Date Cemetery or Crematory
05/14/2018 Pine View Crematory
r ❑Entombment Address
;. ®Cremation Queensbury, New York
Date Place Removed
''- ❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
if 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
0 53 Quaker Rd,Queensbury,New York 12804
k Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
y Date Issued 05/10/2018 Registrar of Vital Statistics Wc6ertA Curtis(E(ectronicaffySigned)
(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:
Date of Disposition sIII II( Place of Disposition f,4 4,0e <r�J- .v
(address)
(section) (lot numbe (grave number)
Name of Sexton or Person in Charge of Pre ises fA 3 fv-tif
`�' ( lease print)
Signature '^^ Title rp cmi�
(over)
DOH-1555(02/2004)