Dowmont, William NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Chester Dowmont Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 15, 1996 82 War or Dates �, .- ✓
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Richard T. Hogan MD
Address
325 Main Street, Hudson Falls, NY 12839
' Death Certificate Filed Glens Falls District Nurr�b661
City, Register Number
'> T # 5
Date Cemetery or Crematory
❑Burial April 17, 1996 Pine View Crematorium
Address
>: Cremation Tn of Queensbury, NY 12804
FDate Place Removed
0 ❑Removal and/or Held
•• and/or Address
Hold
0 Date Point of
N❑Transportation Shipment
C 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 Main St., Hudson Falls, N.Y. 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
au
Permission is hereby granted to dispose of the human remains described ove as indi d
Date Issued �� �9-� Registrar of Vital Statistics 1?,,�e' �
(signature)
5601 Place Glens Falls, NY
District Number
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition �f— 7� Place of Disposition 1�J hl U+� C)(z0,M. to
(address)
LJJ
t/J
� (se 'o�)� ���(Iotn ber (grave number)
OName of Sexton or Person in Charge of Premises
g (please print) L
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61