Weaver Jr, William . A -"ifft
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
is Name First Middle Last Sex
William J. Weaver Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 11 / 2017 84 War or Dates 1950-1953
Place of Death Hospital, Institution or
ZCity, Town or Village Greenfield Street Address 59 Daketown Road
a Manner of Death® Natural Cause E Accident �Homicide �Suicide ❑Undetermined 7 Pending
Circumstances Investigation
ui Medical Certifier Name Title
C Kevin B. Costello MD
Address
178 Washington Ave. , Albany, NY 12203
Death Certificate Filed District Number Register Number
City,Town or Village Greenfield
ElBurial Date Cemetery or Crematory
10 / 13/ 2017 Pine View Crematory
Entombment Address
'»ECremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
0
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
j Q Disinterment Date Cemetery Address
< ' Q Renterment Date Cemetery Address
1
Permit Issued to Registration Number
'' Name of Funeral Home Compassionate Funeral Care 00364
] Address
402 Maple Ave. , Saratoga Sp., NY 12866
<s Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
l
i>�
Permission is hereby granted to dispose of the human r mains described above as indicated.
iiig Date Issued I b y-i 3-ab 1'1 Registrar of Vital Statistics S ci-LA.re.,--,
(signature)
Ni
aq District Number 1.-‘55`1 Place Greenfield , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z p
l Date of Disposition /0/131 n Place of Disposition �` 4 a,✓
SE LEI
(address)
Ca
CC (section) (lo;number) (grave number)
CI Name of Sexton or Person in Charge Premises G hr. St- )
Z
s (plese print)
ta Signature ( � �t
g Title h
(over)
DOH-1555 (02/2004)