Loading...
Herbaly, William George 't30 NEW YORK STATE DEPARTMENT OF HEALTH LF Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William George Herbaly Male Date of Death Age If Veteran of U.S.Armed Forces, 01/10/2022 81 Years War or Dates 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 0 Suicide ❑Undetermined Pending 11.1 Circumstances Investigation W0 Medical Certifier Name Title 0 Aaron Heckler PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 25 ❑Burial Date Cemetery,Crematory or Facility Name 01/11/2022 Pine View Crematory 0 Entombment Address lCremation Queensbury Town,New York ❑Donation 0 Removal Date Place Removed and/or and/or Held H inHold Address 0 O. 1-1❑ Date Point of Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom 11.- Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/11/2022 Registrar of Vital Statistics Megan Nolin(Electronically 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: Z Date of Disposition 1 /lI 1ZZ Place of Disposition 2 ( dress/ W CC N (section) A(lotnumber) (grave number) 11. a Name of Sexton or Person in Charge of Premises 014 2 (pleas tint) rnn W Signature Title "iota, DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#