Hoffer Sr, William NEW YORK STATE DEPARTMENT OF HEALTH t N.
it act 10
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Scott Hoffer Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 11, 2013 47 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death a Natural Cause ElAccident 1 1 Homicide ❑ Suicide n Undetermined n Pending
0 Circumstances Investigation
W Medical Certifier Name Title
Frances Bollinger MD,
Address
161 Carey Rd Queensbury, NY 12804
Death Certificate Filed District Number Register pir
City, Town or Village 5601
❑Burial Date Cemetery or Crematory
July 15, 2013
❑Entombment Address
®Cremation
Date Place Removed
z ❑ Removal and/or Held
• and/or Address
Hold
CO' Date Point of
� pi Transportation Shipment
(0 by Common Destination
0' Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2' Address
a::
W=
a. Permission is h eby granted to dispose of the human remains descrii$ a v iyi
Date Issued ,5-do Registrar of Vital Statistics �'�'
(signature)
District Number 5601 Place 67Pz, .fl / /,2 Pz7l/
HI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ui Date of Disposition 7-fl t Place of Disposition 'Pi Pe0pv -ctavg '-
(address)
W
W.' (section) (lot number) C (grave number)
0 g• Name of Sexton or Pers n in Char a Premises delfil ,J
(please print)
W: Signature Title C el))ft
(over)
DOH-1555 (02/2004)