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Barrett, William NEW YORK STATE DEPARTMENT OF HEALTH 4 11` Vital Records Section Burial - Transit Permit Name First Middle Last Sex 414 ks William Barrett Male fit Date of Death Age If Veteran of U.S. Armed Forces, 10/14/2018 64 Years War or Dates Place of Death Hospital, Institution or . City, Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death©Natural Cause []Accident Ei Homicide 0 Suicide �Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Rafael Cardona rodriguez MD XV Address 43 New Scotland Ave,Albany,New York 12208 c Death Certificate Filed District Number Register Number itr Ci .,Town or Villa•e Albany 0101 2268 LIBurial Date Cemetery or Crematory 10/16/2018 Pineview Crematorium ❑Entombment Address e ®Cremation Queensbury Town, New York el Date Place Removed ❑Removal and/or Held ;._ and/or Address Hold Date Point of Q Transportation Shipment , by Common Destination ha Carrier Q Disinterment Date Cemetery Address 4 Q Reinterment Date Cemetery Address ve If Permit Issued to Registration Number Name of Funeral Home Radloff Funeral Home Inc i 01425 Address 4,1 136 Warren St,Glens Falls,New York 12801 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. rA Date Issued 10/16/2018 Registrar of Vital Statistics Daniel&S Gillespie(E&ctronwa1lySigned) r:Alt (signature) 1,0 District Number o101 Place Albany, New York li I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition /0 (i1 I IQ Place of Disposition Z4 t,,/ C„41-u,.N, ' (address) (section) (lot number) (grave number) fl Name of Sexton or Person in Charge of Premises iIr.$ ,)eAAti'�' ( se print) Wf Signature 0 Title a mg1(1_ (over) DOH-1555(02/2004)