Baldwin, William 4, .,,
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William C. Baldwin Male
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 07 / 2018 70 War or Dates N/A
14 Place of Death Hospital, Institution or
ZCity, Town or Village Fort Edward Street Address 231 Broadway
0 Manner of Death®Natural Cause ❑Accident Homicide E Suicide 7 Undetermined 0 Pending
Ili0.
Circumstances Investigation
itz Medical Certifier Name Title
G Suzanne Blood MD
Mp Address
161 Carey Road, Queensbury, NY 12804
Death Certificate Filed District Number55 Register 1\ irter
City,Town or Village Fort Edward
riiiiIiiiriBurial Date Cemetery or Crematory
10 / 09/ 2018 Pine View Crematory
LIEntombment Address
riCremation Queensbury, NY
.iii.'i Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
OP Date Point of
thri Q Transportation Shipment
a by Common Destination
giii Carrier
Disinterment Date Cemetery Address
iiiiiiiii
Reinterment Date Cemetery Address
Permit Issued to 1 Registration Number
`' Name of Funeral Home Compassionate Funeral Care 00364
<`f Address
402 Maple Ave., Saratoga Sp., NY 12866
Mi Name of Funeral Firm Making Disposition or to Whom
iTiiii
Remains are Shipped, If Other than Above
2 Address
it
` Permission is hereby granted to dispose of the human re ascribed bov a in ated.
Date Issued I 0-q- Registrar of Vital Statistics
(signature)
U
Mi District Number 5165 Place ) b 7 / Fort Edward , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition to fib l Ig Place of Disposition g, ,,,, C,,,Ar,fs,,,,
Ui (address)
4*
CC (section) (I number) C (grave number)
0 Name of Sexton or Person in Charge of Premises 6 nn� .)f,4N0
z (pleas print) .
it G-(Signature A
Title `V P&
•
(over)
DOH-1555 (02/2004)