Hudson, William if 23 g
NEW YORK STATE DEPARTMENT OF HEALTIll
Vital Records Section Burial - Transit Permit
4i Name First Middle Last Sex
William Stephen Hudson Male
Date of Death Age if Veteran of U.S. Armed Forces,
* 03/19/2018 79 Years War or Dates
ia. Place of Death Hospital, Institution or
. City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death El Natural Cause D Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending
Circumstances ""Investigation
Medical Certifier Name Title
Sean Bain MD
;
IAddress
,
arAi,„ too Park St,Glens Falls,New York 12801
212 Death Certificate Filed District Number Register Number
Mit City,Town or Village Glens Falls 5601 140
-1
7, LJ r-,
Burial Date Cemetery or Crematory
„,,, 03/20/2018 Pine View Crematorium
A u Entombment -
Address
OCremation Queensbury Town, New York •
Date Place Removed
9 Removal and/or Held
g_ and/or Address
ar- Hold
id Date Point of
., 9
, Transportation Shipment
by Common Destination
Carrier
1-1 Disinterment
Date Cemetery Address
L j
.. ,
._..L j,Reinterment Date Cemetery Address
:414-
-1. Permit Issued to Registration Number
ll Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Sipo Box 67,Hudson Falls,New York 12839
-'- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
47, Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03120/2018 Registrar of Vital Statistics Baden otitis(ETharonicaffy Sign4
(signature)
District Number 5601 Place Glens Falls, New York
t
1,04te I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
X 1
W Date of Disposition 31ru11% Place of Disposition 'FU,-, ti,, skt.-,..-,
(address)
Name of Sexton or Person in Charge of Premises (section) (lot number)
IL _ s• SI"it- (grave number)
11 A ,4:4. 41se print)
Signature Title /ppm MI
ig
(over)
DOH-1555 (02/2004)