Pike, William � . • a ii 1b1
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
William H Pike Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/22/2016 83 War or Dates 1953-1955
k-. Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address Albany Medical Center
p Manner of Death Natural ❑ Undetermined ❑ Pending
W ® Cause ❑ Accident Homicide ❑ Suicide Circumstances Investigation
0 Medical Certifier Name Title
CI Dennis P McKenna MD
Address
43 New Scotland Avenue Albany, NY
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 417
Date Cemetery or Crematory
❑ Burial 02/24/2016 Pineview Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
H Hold
N
Q Date Point of
d Transportation Shipment
CO ❑ By Common Destination
Carrier
❑ Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
7 Sherman Avenue Corinth, NY 12822
Name of Funeral Firm Making Disposition or to Whom
F" Remains are Shipped, If Other than Above
Ix* Address
W
d. Permission is hereby granted to dispose of the human remains described above as indicated.
Date 02/24/2016 nQ G(�
Issued �� ��o J
Registrar of Vital Statistics
( gnature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accord ce with this permit on:
I` Date of Disposition 7 I lib Place of Disposition Of%) ,�
Z
L (address)
tll''
co
cc (section) (lot number) (grave number)
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G ,��t C��� ,.�
WName of Sexton or Person in Charge of Pre .ses faT .)r'Y"�V
(please print) 11 �f,�/�
Signature ATitle ` ����I l"' �
(over)
DOH-1555 (02/2004)