Atkinson, Willaim Paul IZig
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Paul Atkinson Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/31/2021 83 Years War or Dates Navy
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
ILI
W• Manner of Death 0 Natural Cause 1:1Accident 0 Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
GMedical Certifier Name Title
Kenneth France MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 76
Burial Date Cemetery,Crematory or Facility Name
02/03/2021 Pine View Crematory
Entombment Address
gCremation Queensbury,New York
Donation
Z• Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
❑
d Date Point of
(I) Transportation
p by Common Shipment
Carrier Destination
❑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
2 Address
Q
W
n" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/02/2021 Registrar of Vital Statistics 2odert/?rulrew attic gkctronicalry 49,ne4
(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:
Date of Disposition 21K it( Place of Disposition OIL A____
W
2 (address)
W
CO (section) (lot mber) (grave number)
Name of Sexton or Person in Charge of emises 1 ru t, 5 at
Z /�(please prim /� ��n
W Signature t Title ` I/���-
DOH-1555(07/18)p 1 of 2
1
Public Health Law Sec. 4145(2b) 01 44 94
Receipt
Human remains of .`* delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#