Loading...
Mound, William Paul NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Paul Mound Male Date of Death Age If Veteran of U.S.Armed Forces, 02/05/2021 58 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death W El Undetermined Pending© Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title 0 Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 84 Burial Date Cemetery,Crematory or Facility Name 02/08/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held H Hold Address to 0 CL Date Point of (I) ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 F- Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2021 Registrar of Vital Statistics WpbertAndrew 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: Z jL 1111 Date of Disposition Z l5 I Zi Place of Disposition c� 2 (address) W N (section) (lot num rA- _ (grave number) Name of Sexton or Person in Charge of Premise /`' �'" Z (please print) l! W Signature ,-. Title DOH-1555(37/18)p i of 2 • Public Health Law Sec. 4145(2b) L 4 5 71 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#