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Vaughn, William NEW YORK STATE DEPARTMENT OF HEALT14 - # 3°1 Vital Records Section ,.' Burial - Transit Permit Name First Middle Last Sex William C. Vaughn Male Date of Death Age If Veteran of U.S. Armed Forces, 05/23/2013 53 years War or Dates 1981-1987 Place of DeathulZ Hospital, Institution or City, xyarxxxvonot Saratoga Springs Street Address wesley health care center Manner of Death©Natural Cause ElAccident ElHomicide ElSuicide ❑Undetermined Pending tii Circumstances Investigation W Medical Certifier Name Title O Rick D. Teetz M. D. Address 131 Lawrence Street, Saratoga Springs N Y Death Certificate Filed District Number Register Number City, TONMX1,104Xtie Saratoga Springs 4501 232 ❑Burial ' Date Cemetery or Crematory ['Entombment Address Pineview Crematorium Address < ,©Cremation Queensbury N Y • Date Place Removed Z❑Removal and/or Held 2 and/or Address t: Hold 0 Date Point of o Transportation Shipment a by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number <! Name of Funeral Home Densmore Funeral Home 00448. Address 7 Sherman Ave, Corinth, New York 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address tU fl` Permission is hereby granted to dispose of the human re s es ibe s indic ted. Date Issued 05/24/2013 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs a.::: I certify that the remains of the decedent identified above were disposed of in ccordance with this permit on: p 517SI Dispositioner. C t�• Date of Disposition Place of � ;vrt 444., 2 (address) W UV W (section) (10 umber) (grave number) CV ci Name of Sexton or Pers in Charge o Premises r,Y �E".f►T 2► (please prir t) iioi Signature Title CM��}f� (over) DOH-1555 (02/2004)