Hewitt, William Zoe,
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section t Burial - Transit Permit
. v.
Name First Middle Last Sex
WILLIAM ISAAC HEW ITT MALE
Date of Death Age If Veteran ofU.S.Armed Forces,
04/08/2012 86 War or Dates WW II
1- Place of Death Hospital, Institution
W City ,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
0 Manner of Death Natural El
Undetermined ❑ Pending
LU El Natural
❑ Accident ❑ Homicide ❑ SuicideCircumstances Investigation
° Medical Certifier Name Title
0 JORGE CORONA MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 713
Date Cemetery or Crematory
❑ Burial 04/16/2012 PINE VIEW CREMATORY
El Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
o ❑ and/or Address
H' Hold
Date Point of
;' Transportation Shipment
CO ❑ By Common
''1 Carrier Destination
El Disinterment
Date Cemetery Address
ElDate Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home M.B. KILMER F.H. 01078
Address
136 MAIN ST., GLENS FALLS NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
el Address
W
n- Permission is hereby granted to dispose of the human remains described above as in ateit df
Date 04/10/2012 Registrar of Vital Statistics , Vl�t� - ``� -'' r� -
Issued (signature) �(
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
li Date of Disposition 44 id,I(t Place of Disposition 1M,L;w C640f►..-
w (address)
W
z (section)
(lot number) (grave number)
w Name of Sexton or Person in Charge of Premises (�� t r- !
(please print) r
Signature 4 Title CQit NAtYt
(over)
DOH-1555 (02/2004)