Ramsey, William NEW YORK STATE DEPARTMENT OF HEALTH t 4" 4 t 137_
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William J. Ramsey Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 9, 2011 82 War or Dates
1 Place of Death j Hospital, Institution or
Z City, Town or Village Glens Falls 1 Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
US Circumstances Investigation
to Medical Certifier Name Title
P. Christopher Hoy MD
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 / 23
❑Burial Date Cemetery or Crematory
March 11,2011 Pine View Cremation
❑Entombment Address
�x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
�' Hold
N
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
—
Disinterment Date Cemetery Address
ReintermentI
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan Minahan & Potter ! 01675
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
t'- Remains are Shipped, If Other than Above
5 Address
Az
bli
, Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3/ JO/i i Registrar of Vital Statistics (jDC —ice .
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3`ig-ii Place of Disposition 4Lu1 Cten►cfiinrti
2 (address)
LU
co
rt (section) (lo umber) (grave number)
pName of Sexton or Person in Char of Premises act, r . e40
Z (please prin
W
Signature Title CUM mort
(over)
DOH-1555(02/2004)