Stanton, William , ,. ...--1,!) Cl i
NEW YORK STATE DEPARTMENT OF HEALTH 1 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William C. Stanton Male
Date of Death Age If Veteran of U.S. Armed Forces,
02111/2012 76 years War or Dates 195.4_- 1957
t- Place of Death Hospital, Institution or
f City, Tow it Street Address
iii ( ARAXX Glens Falls Glens Falls Hospital
a Manner ofDeathLiv Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
0.
tu Medical Certifier Name Title
0 Named A. Sidderg M D
Address
• Glens Falls Hospital 100 Park Street Glens Falls
Death Certificate Filed District Number Register Number
City, TowgnVill gtxx_ Glens Falls 56(11 61
0 Burial Date Cemetery or Crematory
[]Entombment 02/1,3/2019 • Pine View CrPmatc rium
Address •
`1i1C,yemation Queensbur}t, NY 12804
Date Place Removed
EFIRemoval • and/or Held
le L'j and/or Address
Hold
0 Date Point of
05 Q Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date - Cemetery Address
Q Reinterment Date Cemetery Address
Permit issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
1 - Remains are Shipped, If Other than Above
a Address
tr
U-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/13/2012 Registrar of Vital Statistics t A) C % i �1l,
(signet e)
District Number 5501 Place Glens Falls
I certify that the remains of the decedent identified above were dispo d of in accordance with this permit on:
ka.::
ill Date of Disposition kL IS Zdt2 Place of Disposition -Vt.-Lt.) 6,,...a f,,,,�,
(address)
ill
MI
CC (section) 1( (lot number) (grave number)
/((
G Name of Sexton orperson in Charg of Premises ( h,,sk i^ c,�(}-
Z lit /f � (please print)
Signature f.�7p� Title Cu[Al AT V 1.
(over)
DOH-1555 (02/2004)