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Heid, William NEW YORK STATE DEPARTMENT OF HEALTH k (g ' Vital Records Section Burial - Transit Permit Name First Middle Last Sex William M. Held Male Date of Death Age If Veteran of U.S. Armed Forces, February 15,2013 84 War or Dates Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation ui Medical Certifier Name Title G MD Address HHHN,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 6 'j ❑Burial Date Cemetery or Crematory Entombment Address 19,2013 Pine View Crematory Address ❑X Cremation 21 Quaker Rd.,Queensbury,NY 12804 Date Place Removed ZI I Removal and/or Held and/or Address t' Hold rn O Date Point of NTransportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 t- Remains are Shipped, If Other than Above a Address EL' a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 2-15-13 Registrar of Vital Statistics U\► �(signat re) District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: T 0 /? W Date of Disposition 2-Z©-�3 Place of Disposition 110 W (address) CO (section) /J(lot number) (grave number) pName of Sexton or Perso in Charge of P mises `f r, ,<VIVAL `Z (plea print) Signature ts,._ Title Gule3444113 t. (over) DOH-1555 (02/2004)