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Lueth, William Paul NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex William Paul Lueth Male Date of Death Age If Veteran of U.S.Armed Forces, 10/25/2020 92 Years War or Dates 1946-1947 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W p Manner of Death 0 Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined El Pending W U Circumstances Investigation WW Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 488 ©Burial Date Cemetery,Crematory or Facility Name 10/31/2020 Pine View Cemetery Entombment Address ElCremation Queensbury Town,New York 0 Donation OZ ❑Removal Date Place Removed H and/or and/or Held Hold Address 0 a. Date Point of CO ❑Transportation by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above „r Address CC 111 EL' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/27/2020 Registrar of Vital Statistics Ro6ert_1narrewCurtrs(Ekctronicall;Signed/ (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Il— W Date of Disposition 1 0/31 /2020 Place of Disposition 21 Quaker Rd_ Que nshiiry, NY 1 2804 2 (address)" W Mohawk 91 1 CC N (section) (lot number) (grave number) Name of Sexton o Person in Charge remises Connie Goedert (please print) W Signature /iI1440- e Title Superintendent DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 012 818 Receipt Human remains of\'- \ \\; , __., -1 delivered on i. _f, '' , 20; . // fil ,,,\ ii/ t'%Pine V,idcv Cemett4 Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# I_1 I,- LUETH : LF)NAME William Paul Lueth Age: 92 ``,� Lot Owner: William P. & Jacqueline P. Lueth Lot# Mohawk 91 Grave# 1 Case: Concrete Died: Interred: 10/25/2020 10/31 /2020 Funeral Home: Baker FH Cemetery: Pine View