Sheldon Sr, William NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Timothy Sheldon Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 28, 1994 78 War or Dates VW II
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Eden Park Nursing Home
Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Robert L. Evans MD
Address
3 Irongate Center, GLENS FALLS, NY 12801
Death Certificate Filed District Number Register Number
City, TAWAVXYiRaMGlens Falls 5601 °yam
Date Cemetery or Crematory
❑Burial August 1, 1994 Pine Vier Crematorium
x Address
u Cremation' Tn of Aueensbury, NY 12804
Date Place Removed
❑Removal and/or Held
0 and/or Address
P.
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc. 00310
. Address
P.O. Box 67, 68 Bain St., Hudson Falls, N.Y. 12839
Name of Funeral Firm Making Disposition or to Whom
X.
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 9 i % Registrar of Vital Statistics 70-tK&,
(signature)
[ District-Number 5601 Place City of Glens Falls NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Place of Disposition /�j/✓,E' !�/,� ��,�iYf� / �l!J
(address)
iIJ
>l (section) (lot number (grave number)
GName of Sexton r Person 17 Charge of Premises ��D /17, ��,gl�,�
z (please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61