Howe, William :. CINEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex
: William Howe Male
Y' Date of Death Age If Veteran of U.S. Armed Forces,
December 31, 2010 80 War or Dates
Z. , Place of Death Hospital, Institution or
; City, Town or Village Queensbury Street Address Apt 317 Willowbrook Road
• Manner of Death ✓ Natural Cause I I Accident I I Homicide Suicide I I Undetermined Pending
gi Circumstances Investigation
Medical Certifier Name l�•^��f - Title
�, Addres �A t'X�t q
(pcv� Fl of tJf1
Death Certificate Filed I District Number Register mber
.rt.:1 City, Town or Village Queensbury 5657 47/
❑Burial Date Cemetery or Crematory
January 3, 2011 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
O and/or Address
H Hold
N
O Date Point of
O.
N Transportation 1 Shipment
p by Common Destination
Carrier
Disinterment Date 1 Cemetery Address
Reinterment Date Cemetery Address
__,:; Permit Issued to ' Registration Number
A, Name of Funeral Home Singleton-Healy Funeral Home 01622
Address
407 Bay Road, Queensbury, NY 12804
:a, Name of Funeral Firm Making Disposition or to Whom
k►+, Remains are Shipped, If Other than Above
g; Address
re
Uf
.` Permission is hereby granted to dispose of the human remains des ribed abov as indicated.
Date Issued 67'e_3--ad// Registrar of Vital Statistics kilA- 't f
: (signature) /{"
District Number 5657 Place Queensbury
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition —,..et ;i 2010 Place of Disposition f L V,r�.,1 Cvmcf,xt.,L
2 (address)
w
co
re (section) (lot�n `''ber) (grave number)
pName of Sexton or Person in Char a of Premises ( 1 .. Ac htd- So u'4t
Z (please print)
Ill (
/, 41.1/4.„ Title (I/t: A)011.(Z
Signature
(over)
DOH-1555(02/2004)