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Bemis, William James . • 0 y Z NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William James Bemis Male Date of Death Age If Veteran of U.S.Armed Forces, 06/07/2021 78 Years War or Dates ZPlace of Death Hospital,Institution or City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare a Manner of Death ©Natural Cause ❑Accident El Homicide ❑Suicide 0 Undetermined El Pending 11.1 Circumstances Investigation W Medical Certifier Name Title a Leonard Gelman MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 39 ❑Burial Date Cemetery,Crematory or Facility Name 06/10/2021 Pine View Crematory riEntombment Address ii Cremation Queensbury,New York ❑Donation Removal Date Place Removed and/or and/or Held f- Hold Address N 0 0• Date Point of U)❑Transportation Q by Common Shipment Carrier Destination 1❑Disinterment Date Cemetery Address i Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 4, Remains are Shipped,If Other than Above Address llt in d Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/10/2021 Registrar of Vital Statistics Shelley lIckernon(ECectronicaITy 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 W Date of Disposition 6,_a-2D2/ Place of Disposition ..P, Oe._. d.Lu] lnrP�Yr eE/c my 2 (addre0 J W CC (section) / (lot numb r) (grave number) 8 Name of Sexton or Person in Cha f Premises ' R,4 l n)1d iihod Z (please print/ Signature _ 7/. ye 0 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ,_)148 t Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#