Briggs, William NEW YORK STATE DEPARTMENT OF HEPPLTH
Vital Records Section Burial - Transit Permit
iig Name First Middle Last Sex
William Floyd Briggs Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/08/2011 76 years War or Dates
Place of Death Hospital, Institution or
ii City, Towitkby�iStreetAddress Glens Falls Hospital
( Glens Falls
0 Manner of Death r—I❑Vatural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
iik! Circumstances Investigation
ta Medical Certifier Name Title
Suzanne M Rayeski M I)
Address
Warrensburg Health Center Main St. Warrensburg, NY
Death Certificate Filed District Number Register Number
City, TowilkobyiliAtliexx (;tans Falls 5601 58
❑Burial Date Cemetery or Crematory
❑Entombment 07/11/2n13 Pine View Crematorium
mi❑ Address
iiiiiiii Cjemation Queensbury, NY 12804
Date Place Removed
Z ri❑Removal and/or Held
ii and/or Address
H Hold
CO
C? Date Point of
w Transportation Shipment
❑it
2 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
W:iEl Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Rii Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
C
ll
Permission is hereby granted to dispose of the human remains descri ed a ov s i d.
Date Issued 02/11/2013 Registrar of Vital Statistics 2;
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
C.rvrrr{a r
l� Date of Disposition /-�Z-t3 Place of Disposition ,�U�,
(address)
t
t
CC (section) (lot number) (grave number)
ta Name of Sexton or Pers n in Charge f Premises A:;Actits— . •vitik
(please print)
Signature Title Ct4lMTO 4,
(over)
DOH-1555 (02/2004)