Chandler, William NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle L t Sex
William � andler Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/09/2015 62 years War or Dates
P of Death Hospital, Institution or
City, X (dfr (aX Glens Falls Street Address Glens Falls, N Y
er of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
P. John Stoutenburg M D
. Addres
102 ark Street Glens Falls, N Y 12801
iil th Certificate Filed District Number Register Number
M. Ci TdWrrr IMP Glens Falls 5601 444
urial Date Cemetery or Crematory
09/10/2015 Pine View Crematory
['Entombment Address
G Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
I= Hold
to
0 Date Point of
65 ❑Transportation Shipment
0 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Ai Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01078
Address
136 Main Street South Glens Falls, N Y 12803
Name of Funeral Firm Making Disposition or to Whom
} Remains are Shipped, If Other than Above
Address
iU
C Permission is hereby granted to dispose of the human remains described
aboo e as•i ated.
/4,1a1Date Issued 09/10/2015 Registrar of Vital Statistics , ( 1
(signa ure)
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:
ILI Date of Disposition 1/0 15— Place of Disposition g4d.,—/ �rLct¢rn _.
2 (address)
Il
at
cc (section) A(lot number) (grave number)
ct Name of Sexton or Person in Charge Premises (hr,, 1, 62311•44A1`
(pl se print)
la Signature u� Title 1aimiti (L
(over)
DOH-1555 (02/2004)