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Murray, William Gerald Qd NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Gerald Murray Male Date of Death Age If Veteran of U.S.Armed Forces, 11/22/2021 66 Years War or Dates l— Place of Death Hospital,Institution or Z City,Town or Village Lake George Town Street Address 54 Sewell Street, Lake George Town, New York 12845 pManner of Death ©Natural Cause 12 Accident El Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Lake George 5651 22 ElBurial Date Cemetery,Crematory or Facility Name 11/26/2021 Pine View Crematory 0 Entombment Address 0 Cremation Queensbury Town,New York ❑Donation ElRemoval Date Place Removed and/or and/or Held - Hold Address (/) 0 a Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 5 Address rc C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics Tatricia c 4c'l(inney Schuster(E(ectronicafySigned) (signature) District Number 5651 Place Lake George, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition ll-.30-2p 11 Place of Disposition P; N P 0 1)VA-0 C rein q 2 (address W CC (section) �/ ] (lot nu/mb�r) (grave number) 0 Name of Sexton or Person in Charge of Pre is A 7 �f1 11 r0 C W�� r� � (please print) W Signature <":.,../i,j7// Title 0��1'c DOH-1555(07/18)p i of 2 1_ 5 74 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#