Morehouse, William NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William F. Morehouse Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 10,2011 52 War or Dates
Place of Death Hospital, Institution or
iiZ City, Town or Village Thurman Street Address 882 Zaltz Road
p Manner of Death X Natural Cause Accident Homicide Suicide I I Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Paul Bachman
Address
MIEN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Thurman 5659
❑Burial Date Cemetery or Crematory
ID Entombment July 11,2011 Pine View Crematory
Address
Ex Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
F Hold
O Date Point of
ra I I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
I
Reinterment Date Cemetery Address
Permit Issued to I Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00.035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
E Address
CC
W
a
Permission is her by ranted to dispose of the human r ains described a indicated.
Date Issued / ` Registrar of Vital Statistics (�
(sign re)
District Number 5659 Place Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
11^ '
UJ Date of Disposition ipvit Place of Disposition 421 ry UEty ( /v..c dit`,
(address)
co
(section) (lot number)e--- (grave number)
pName of Sexton or Per n in Charge of remises jhr
(please print)
W
Signature Title CR f:hA1142
(over)
DOH-1555 (02/2004)