Kanaly, Sr. William NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William J. Kanaly,Sr. I Male
Date of Death Age If Veteran of U.S. Armed Forces,
° February 4, 2011 83 War or Dates World War II
Place of Death Hospital, Institution or
:Z City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death I 'Natural Cause ,Accident Homicide Suicide I I Undetermined Pending
US Circumstances Investigation
Medical Certifier Name Title
:I
Address
Death Certificate Filed j Distric Number ' Regis r Number
.' City, Town or Village Ft.Edward 175 I
D Burial Date Cemetery or Crematory
February 8, 2011 Pine View Crematorium
❑Entombment Address
E1 Cremation 21 Quaker Road, Queensbury, NY 12804
Date 1 Place Removed
ZZ Removal ; and/or Held
and/or Address
H Hold
W
0 Date Point of
N Transportation , Shipment
p by Common Destination
Carrier
1- Disinterment Date Cemetery Address
IReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home I 01464
Address
53 Quaker Road, Queensbury, NY 12804 _
Name of Funeral Firm Making Disposition or to Whom
!*m Remains are Shipped, If Other than Above
Address
1e
.US
' Permission is h eb granted to dispose of the human ains describ ove a indicated.
Date Issue ] `/. Registrar of Vital Statisti s ,,(_, /
(signature)
District Numbe � Place Ft.Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 201 Place of Disposition t ' Uto4. Gi ►-� ofw&
W Date of Disposition �� '�i ( p t
2 (address)
W
Cl)
0 (section) )j (lot n er) (grave number)
—
a Name of Sexton or Person4).......
in Charge of Premises 4e,„{-cpAN- .,NZ r/�� _ (please print)
W Signature Title Cl?OP)P(U—
(over)
DOH-1555(02/2004)