Tucker, William LleV
NEW YORK STATE DEPARTMENT OF HEALT1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William D. Tucker Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 18,2017 57 War or Dates
1. 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 Suicide Undetermined Pending
Circumstances Investigation
2 Medical Certifier Name Title
C` Robert Beaty Dr.
Address
100 Broad St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 6 65
❑Burial Date Cemetery or Crematory
12/26/2017 Pine View Crematory
El Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl) -
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ip
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued t"2,.( 26 1 201-7 Registrar of Vital Statistics AQ..LA p (..A}
(signatur
District Number 5601 Place Glens Falls/M y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition 12 1 /7 Place of Disposition ?dig_ v re.....) 6_,..i i -t 4,-y
2 / (address()
CO
re (section) (lot number) (grave number)
Q Name of Sexton oorr/Perso 'n Charge of Premises i;,,../`a.vt 6 4,rn4 c-4_ -e
W / /J/� (please print)
Signature f�/',/ � Title e'�.0 r,'t 4- i.,----
f (over)
DOH-1555 (02/2004)