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Blair, William J.
# 333 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William J Blair Male Date of Death Age If Veteran of U.S.Armed Forces, 04/06/2021 52 Years War or Dates Place of Death Hospital,Institution or MU City,Town or Village Albany Street Address Albany Medical Center Hospital 0 Manner of Death ©Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending 11111 Circumstances Investigation W Medical Certifier Name Title aAriel Nash MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0961 Burial Date Cemetery,Crematory or Facility Name 04/07/2021 Pine View Crematory IDEntombment Address 0 Cremation Queensbury Town,New York ElDonation Q❑Removal Date Place Removed and/or and/or Held Hold Address Transportation Date Point of ZS by Common Shipment Carrier Destination 0 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 } Remains are Shipped,If Other than Above 2— Address tr W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/07/2021 Registrar of Vital Statistics (Danie(fz S Gi((espie(E(ectronica1Ty Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition yl$/7� Place of Disposition l �1 at. W 2 (address) W Q (section) (/ umber) (grave number) E g Name of Sexton or Person in Charge of Premises i no L. � + 11 Z (please pr t) W Signature 0 Title /004`17 Wlet DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .' 14 7 f I 1 Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i