Wetherbee, Willaim B 4 BSI
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William B.Wetherbee Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/06/2021 88 Years War or Dates 1955-1957
Place of Death Hospital,Institution or
Z City,Town or Village Wilton Town Street Address 60 Waller Road,Wilton Town,New York 12831
LU
W Manner of Death ❑X Natural Cause ❑Accident El Homicide ❑Suicide Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
Madison Zuis NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 39
❑Burial Date Cemetery,Crematory or Facility Name
08/09/2021 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
❑Donation
• Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
Cl) ❑Transportation
isby Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
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
F. Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2021 Registrar of Vital Statistics Susan Baldwin(E/ctronicall:y Send)
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H �
W Date of Disposition 8i5 (14 Place of Disposition
2 (address)
W
cc (section) (tot number) (grave number)
Name of Sexton or Person in Charge of Pre ises
Z (plea print)
W Signature Title `
DOH-1555(07/18)p 1 of 2
18
Public Health Law Sec. 4145(2b)
Receipt
Human remains of _ , delivered on , 20 '
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#