Truesdale, William 8
# 37.g
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Truesdale I Male
Date of Death Age If Veteran of U.S. Armed Forces,
June 4,2013 91 War or Dates
Place of Death Hospital, Institution or
iZ City, Town or Village Bolton 1 Street Address 17 The Moorings
p Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
LU Circumstances Investigation
C)
u,i Medical Certifier Name Title
p Bryan Smead
Address
Bolton Health Center,Bolton Landing,NY 12814
Death Certificate Filed District Number Register Number
City, Town or Village Bolton 5650
❑Burial Date Cemetery or Crematory
❑Entombment June 5,2013 Pine View Crematory
Address
CI Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
1' Hold
N
0 Date Point of
Transportation 1 Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
I
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home , 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
2 Address
W
iL Permission is hereby granted to dispose of the human remain des ibed above as indicated.
Date Issued 0(.9- CO-I 3 Registrar of Vital Statistics
(sig ture)
District Number 5650 Place Bolton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uZ.i Date of Disposition Col VI 13 Place of Disposition it it ►, C retd'iv+,-
2 (address)
uJ
(section) (lo number)< //�� (grave number)
pName of Sexton or Person 'n Charge of Pr mises /iii t�"�Pf
Z + (p ase print)
W L Title CGCiy`a`i'ir...
Signature
(over)
DOH-1555 (02/2004)