Towers, William t 741 It 3Q3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
WILLIAM R. TOWERS M
Date of Death Age If Veteran of U.S. Armed Forces,
06-08-2011 34 War or Dates
I- Place of Death Hospital, Institution or
Z City, Town or Village MOREAU Street Address
0 Manner of Death ❑Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
tu• Medical Certifier Name Title
O JOHN DEMARTINO CORONER
Address
339 Northline Road, Ballston Spa, NY 12020
Death Certificate Filed District Number Register Number
City, Town or Village MOREAU 4562 13
❑Burial Date Cemetery or Crematory
06-14-2011 Pineview Crematory
❑Entombment Address
®Cremation Queensbury, NY 12804
Date Place Removed
Z❑Removal and/or Held
and/or Address
— Hold
CA
0 Date Point of
EL i—i
Transportation Shipment
O by Common Destination
Carrier •
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00442
Address
7 Sherman Ave. , Cori_nth,NY 12822
Name of Funeral Firm Making Disposition or to Whom
tp Remains are Shipped, If Other than Above
• Address
la
it' Permission is hereby granted to dispose of the human remains described abo as indicated.
Date Issued %j ae// Registrar of Vital Statistics _9., 7
/��
(signature)
District Number //J 4,2, Place /efyyt,c-ii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 4'1lr-ti Place of Disposition LUv4) C. Kter*.
2 (address)
Ili
fa
CC (section) (I umber) (grave number)
flName of Sexton or Pers n in Charge of remises 4•Atik.i `-'f"
2, (please print)
W. e G�1� Title '�► r
Signatur pl-
(over)
DOH-1555 (02/2004)