Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Lewry, William Andrew
e6,62 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Andrew Lewry Male Date of Death Age If Veteran of U.S.Armed Forces, 10/14/2021 66 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 4 Putnam Avenue,Fort Edward Town, New York 12828 `p Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined El Pending U Circumstances Investigation WC1 Medical Certifier Name Title Laurie Dennison NP Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 60 ❑Burial Date Cemetery,Crematory or Facility Name 10/16/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Fort Edward Town,New York ❑Donation g ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of fA j Transportation 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 F. Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/15/2021 Registrar of Vital Statistics Aimee L fMahoney(ECectronicaCCy Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I!— W Date of Disposition //-)62-2y2( Place of Disposition P7 (address W CC N (section) (lot number) (grave number) gName of Sexton or Perso in Charge of Premises �w1�G,,� (please/print) W Signature Title C f'Q—�✓�o1T!rf �� DOH-1555(07/18)p 1 of 2 1 • .t. ; . , Public Health Law Sec. 4145(2b) w Receipt Human remains of delivered on , 20 Pike View Cemetery Representing the funeral home named on burial,permit dfficial Funeral Directors Reg.or License# ' ~" `"