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Williams, Robert N.
NEW YORK STATE DEPARTMENT OF HEALTH i i LI Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Robert N Williams Male Date of Death Age If Veteran of U.S.Armed Forces, 12/01/2020 86 Years War or Dates 1954-56 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death W 11 Undetermined Pending©Natural Cause �Accident �Homicide Suicide Circumstances investigation W Medical Certifier Name Title 0 Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 546 ❑Burial Date Cemetery,Crematory or Facility Name 12/03/2020 Pineview Crematory ElEntombment Address Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H Hold Address 1-1 O Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom �... Remains are Shipped,If Other than Above a Address W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (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: ZDate of Disposition IL /3 ?p Place of Disposition ddress/ W EC /section/ fftnumber/ (grave number) 0 Name of Sexton or Person in Charge remises 1n (please riot) • Signature Title (, 'T( let DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 0142 E 6 Receipt Human remains of '` 'r, delivered on } , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#