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Ashe, William 93 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit giiii Name First Middle Last Sex William _ Robert _ Ache Male iiiiig Date of Death Age If Veteran of U.S. Armed forces, in 3/13/2013 83 War or Dates Korea Place of Death Hospital, Institution or City, Town or Village Granville I Street Address Orchard Health & Rehab Ctr ca Manner of Death©Natural Cause El Accident 1=IHomicide El Suicide El Undetermined Pending f Circumstances Investigation 42 M'kJedical Certifier Name Title 43 Sean Kimball MD Address Granville Family Health, Granville, Ny Death Certificate Filed District Number © I Register Number a City, Town or Village Date Cemetery or Crematory ii El Burial 2/1 5/2 01 3 Pine View Crematorium [� Address X Cremation Queensbury, NY Date Place Removed 0 ❑Removal and/or Held �• and/or Address Hold Q Date Point of fli$El Transportation Shipment E by Common Destination Carrier ::::: Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to .Registration Number gii Name of Funeral Home Carleton Funeral Home, INc. , 00281 Oi Address 68 Main St. Hudson Falls, NY 12839 M. Name of Funeral Firm Making Disposition or to Whom "" Remains are Shipped, If Other than Above Address CC fAi IX Permission is hereby Granted to dispose of the human remains described above as indicated, liiN Date Issued Qa/I y 4 D 13 Registrar of Vital Statistics iw�a4 gnature .11 District Number 575 Place IbLUAJ 0 - C,-12A'1i/ILL I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: wDate of Disposition 1-IS-t) Place of Disposition 2„.. 4.1.y C-t,,-410ftvr 2 (address) 113 (section) (lot numb (grave number) OL 3 Name of Sexton or Person in Charge of Premises riii(t,, eNtt z I (please print) W Signature j....._ Title CU/W (over) DOH-1555 (9/98)