Eldred, William NEW YORK STATE DEPARTMENT OF HEALTH DI i
Vital Records Section Burial - Transit Permit
rx Name First Middle Last Sex
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William Frederick Eldred Male
r
Date of Death Age If Veteran of U.S. Armed Forces,
December 12, 2015 54 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause U Accident Homicide Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Dr Kyle Leonard,MD
f Address
Di Carey Road,Queensbury,NY 12804
Death Certificate Filed District Number Register Nu ber
r City, Town or Village Glens Falls, NY 5601 8
❑Burial Date Cemetery or Crematory
December 16, 2015 Pine View Crematorium
❑Entombment Address
El Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ• n Removal and/or Held
and/or Address
H Hold
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p Date Point of
Nn Transportation Shipment
'p by Common Destination
Carrier _
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'wry Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
• f
pi Address
Jlfr ri`,r 407 Bay Road,Queensbury, NY 12804
;:
. Name of Funeral Firm Making Disposition or to Whom
; , Remains are Shipped, If Other than Above
Address
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. Permission is hereby granted to dispose of the humans ains described abo as indic ed.
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f< Date Issued /A is. 0/ Registrar of Vital Statistics ( P_e,�-t
, (signature
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District Number Sox)/ Place City of Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 2-f Place of Disposition W Date of Disposition / 7-/S- P p-n e vie,,,, C/'ezeizAoe-i
2 (address)
W
N
re (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises -,u 1%a✓4 G�.eraa.6.4 e
Z (please print)
W Title CI-
Signature �F-
(over)
DOH-1555(02/2004)