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Stewart, William Burton .1 k ID NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Burton Stewart Male Date of Death Age If Veteran of U.S.Armed Forces, 11/14/2021 73 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation LIJ p Manner of Death ©Natural Cause 0 Accident 0 Homicide p Suicide El Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title CI Wendy Steinhacker PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Fiftkl, District Number Register Number City,Town or Village k Glens Falls 5601 515 ElBurial Date Cemetery,Crematory or Facility Name 11/16/2021 Pine View Crematorium ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 Date Point of N ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address 0 Disinterment 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 11/16/2021 Registrar of Vital Statistics R9bert Andrew Curtis(E(ectronica1TySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:n Z Place of Disposition I / IL n�`� W Date of Disposition 11 1 1$1 p (address) W CC (section) (lot number) (grave number) Q3 O Name of Sexton or Person in Charge of P mises nt 1—► KK.4' O (plase print) /� W Signature L�� 7,�" Title l ir',if g DOH-1555(o7/t8)p 1 of 2 ° = . 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#