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Coon, William Randolph NEW YORKSTATE DEPARTMENT OF HEALTH i ` Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Randolph Coon Male Date of Death Age If Veteran of U.S.Armed Forces, 11/09/2020 71 Years War or Dates 1... Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital 0 Manner of Death ©Natural Cause ❑Accident ❑ Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title 0 Sophia Socaris MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2419 ❑Burial Date Cemetery,Crematory or Facility Name 11/11/2020 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 CL Date Point of Ca❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom , Remains are Shipped,If Other than Above M Address C W' C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/10/2020 Registrar of Vital Statistics (Danielle S Cjillespie(Electronically Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit o • W Date of Disposition l l/al Zo Place of Disposition h,,/i1.— o►—... M (a dress) ill CC (section) plot number/ (grave number) 0 Name of Sexton or Person in Charge of� ises ���' Adis Z (p ase print) r ll1 Signature Title OA DOH-1555(o7/18)p 1 of 2 ,-•Public Health Law Sec. 4145(2b) 014196 Receipt Human remains of delivered on • , 20 ;-% Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#