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Stevens, William Gilbert it /S NEW YORKSTATE DEPARTMENT OF HEALTH - ? ' Burial - Transit Permft Bureau of Vital Records Name First Middle Last Sex William Gilbert Stevens Male Date of Death Age If Veteran of U.S.Armed Forces, 02/07/2021 93 Years War or Dates 1945-48 H Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address 4323 State Route 40,Argyle Town,New York 12809 I0 Manner of Death Undetermined El Pending W © Natural Cause 1=1Accident Homicide 1=1Suicide Circumstances Investigation W• Medical Certifier Name Title Wt Kristen Kelley DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village, ,,, Argyle 5750 11 Burial Cemetery,Crematory or Facility Name } 3/2021 Pine View Crematory Entombment Address Cremation Queensbury Town,New York ElDonation Z• Removal Date Place Removed and/or and/or Held Hold Address 0 Q. Date Point of CD ❑Transportation p 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above a Address tr W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/09/2021 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition T1 10 ZI Place of Disposition a &- III g (address) W CC CC (section) (lot n mber) (grave number) O Name of Sexton or Person in Charge of Premisss���eee 111 c4�� Z (please pril /A W Signature Title ` 'M DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014526 Receipt Human remains of • ti delivered on , 20 Pine View Cemetery Representing the-funeral home named on burial permit Official Funeral Directors Reg.or License#