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Grogan, William NEW YORK STATE DEPARTMENT OF HEALTH ` i 9 I Vital Records Section Burial - Transit Permit Name First Middle Last Sex William Jay Grogan Male Date of Death Age If Veteran of U.S. Armed Forces, 11/02/2018 81 Years War or Dates 1956-1964 Place of Death Hospital, Institution or '6 City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Asim Chaudry MD ,14 Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 518 ❑Burial Date Cemetery or Crematory 11/06/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury, New York 2 Date Place Removed Removal and/or Held C'� and/or Address Hold Date Point of ❑Transportation Shipment art by Common Destination Carrier ❑Disinterment Date Cemetery Address a Date CemeteryAddress ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 Oe Address 0 11 Algonkin St,Ticonderoga,New York 12883 6w.c Name of Funeral Firm Making Disposition or to Whom it Remains are Shipped, If Other than Above Address a ` Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/05/2018 Registrar of Vital Statistics t)6ertA Curtis(ECectronica(CySigned) (signature) District Number 5601 Place Glens Falls, New York , I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition It I 1 UI$ Place of Disposition UoIW--) 4(2., IIE (address) iti 0 "' (section) l; (lot number (grave number) Name of Sexton or Person in Charge of Premises n _ ,. g '( jase print) V v, Signature &/: ' Title 11f,611`l4( _ (over) DOH-1555 (02/2004)