Tresten, William Robert ItC
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Robert Tresten Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/07/2021 90 Years War or Dates 1954-1956
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 8 Margaret Dr.,Queensbury Town,New York 12804
p Manner of Death a Natural Cause I=1 Accident 1=I Homicide El Suicide ❑Undetermined 1=1 Pending
Circumstances Investigation
WMedical Certifier Name Title
G Aimee Mcmaster Nurse Practitioner,Acute Care
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 45
Burial Date Cemetery,Crematory or Facility Name
02/10/2021 Pine View Crematory
❑Entombment Address
EiCremation Queensbury Town,New York
ElDonation
ZO ❑Removal Date Place Removed
and/or and/or Held
- Hold Address
U)
0
a- Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped,If Other than Above
2 Address
iW
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/10/2021 Registrar of Vital Statistics Carolinexkkgarfe Bar6er(Electronical5'Swned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: rr
Il. / for-t�„Z Date of Disposition 2�lL� Li Place of Disposition �
ddress)
W
CC
(section) (lot number . (grave number)
Name of Sexton or Person in Charge of Pr es t
�. ,4�
Z L �/� (please print)
LU Signature � Title <v 0i
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) t y C.)1 4``2I
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ,