Weir, Willaim Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Joseph Weir Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/22/2020 60 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
'p Manner of Death ❑X Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
G Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 523
Burial Date Cemetery,Crematory or Facility Name
11/23/2020 Pine View Crematory
❑Entombment Address
Cremation Queensbury,New York
ElDonation
IS Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
Id. Date Point of
CO El Transportation
Q by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
f Remains are Shipped,If Other than Above
Address
lit
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Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/23/2020 Registrar of Vital Statistics RQ6enfrriiewCurtzr(Ekectronicaf 5Wne42
(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:
IF—
Z Date of Disposition 1/-'t3r Zo 20 Place of Disposition /7 yt L V a'C t J a.-.0-4 10.
W (add ess)
uJ
CC N (section) (lot number) (grave number)
gName of Sexton or Pers in C arge remises .k/FAA,, v C`M 4-,_&L
Z (please print)
W Signature Title E- ,, Ivy r9/Dere-
DOH-1555(07/18)p t of 2 //
r y
Public Health Law Sec. 4145(2b) 014 218
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#