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Bills, George Hewitt _ Iti111, NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex George Hewitt Bills Male Date of Death Age If Veteran ALS.Armed Forces, 11/12/2021 53 Years War or Dates h. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide ❑Suicide ❑Undetermined ❑Pending W C.) Circumstances Investigation QW Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 514 ❑Burial Date Cemetery,Crematory or Facility Name 11/16/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z1=1 Removal Date Place Removed and/or and/or Field p.N Hold Address 0 a Date Point of Cl) LI Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above Address CC W 4 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2021 Registrar of Vital Statistics qZg6ertAndrew Curtis(ECectronica1Ty Signed) (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: tu Z Date of Disposition II In litPlace of Disposition �Il Li �i 2 (address) IL CC CC (section) (199number) (grave number) g' Name of Sexton or Person in Charge of Premises 1 t,� di II Z14 (please pint) n W Signaturez7., Title ` '`'tJ�+L DOH-1555(07/18)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 can burial permit Official Funeral Directors Reg.or License#