Watson, William NEW YORK STATE DEPARTMENT OF HEAL1H p B Z��-
Vital Records Section urial - Transit Permit
a; Name First Middle Last Sex
William Watson Male
Date of Death Age If Veteran of U.S. Armed Forces,
;::: April 13,2011 87 War or Dates WWII
'° .: Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Julie Blair Rehab Center
Manner of Death
IX Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Pr, Padma Sripada,MD
Address
325 Northern Blvd.,Albany,NY 12204
.a Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 0101 'MO
❑Burial Date Cemetery or Crematory
April 18,2011 Pine View Crematory
El Entombment Address
I Cremation Queensbury, New York
Date Place Removed
Z Removal and/or Held
and/or Address
1' Hold
N
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
- ' Permit Issued to Registration Number
;Kw; Name of Funeral Home Carleton Funeral Home,Inc. 00276
Address
::, P.O Box 67, 68 Main Street,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
Address
tit°
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued ''p'u /�j)4,9,O(/ Registrar of Vital Statistics 6 CJ . /`C_ppXO ,S co
z%$%{: (signet e)
b : District Number 0101 Place City of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z w Date of Disposition y-Zei-ii Place of Disposition ,mUvr►--0 C101-,410r;,,.,
2 (address)
W
Cl)
CL (section) (lot nu' ber) (grave number)
p Name of Sexton or P "son in Char a of Premises �it,y� �o r- JA....tit- _
Z (please print)
Signature ("4Title Cite roodda—
(over)
DOH-1555 (02/2004)