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Ernst, William Earl 45-0) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Earl Ernst Male Date of Death Age If Veteran of U.S.Armed Forces, 06/14/2021 77 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address St Peters Hospital 0 Manner of Death 11.1 ©Natural Cause 0 Accident El Homicide 1=1 Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title Q Javid Saifi MD Address 315 S Manning Blvd,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1533 ❑Burial Date Cemetery,Crematory or Facility Name 06/17/2021 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York ❑Donation gRemoval Date Place Removed and/or and/or Held H Hold Address to 0 Ca/) Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/17/2021 Registrar of Vital Statistics DanielCe S cil(espie(E(ectronicalTySigned) (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: ILA �Z Date of Disposition (pllitti1 Place of Disposition � address) W CC CC (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Pre ises h 5%44,1i Z (please print) tL Signature Title � ►`►�l�rn, DOH-1555(07/18)p 1 of 2 • Public Health Law Sec. 4145(2b) 1 4 8 E Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Town of Queensbury 411111 Certification of Cremation �N Pine View Cemetery and Crematory This certifies that the remains of: William Ernst were cremated on June , 18 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death June , 14 20 21 Age 77 (Month) (Day) Funeral Home Carleton Funeral Home Registered No. 501 Z._,/,/ .... (Authorized Signature) ERNST NAME William Ernst Age: 77 Lot Owner: Ellen Ernst Lot# Mohican 14 F Grave# 1 Case: Urn Died: 6/18/2021 Interred: 6/21 /2021 Funeral Home: Carleton FH Cemetery: Pine View