Denton, William W. Sr. NEW YORK STATE DEPARTMENT OF HEALTH ell Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William W.Denton Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/21/2021 79 Years Waror Dates
i_ Place of Death Hospital,Institution or
2 City,Town or Village Glens Falls Street Address Glens Falls Hospital
EMannerof Death a Natural Cause Accident Homicide ❑Suicide ❑Undetermined ❑Pending
VCircumstances Investigation
fii Medical Certifier Name Title
Q
Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 626
X Burial Date Cemetery,Crematory or Facility Name
05/1 1/2022 West Glens Falls Cemetery
Entombment Address
❑Cremation Queensbury Town,New York
DDonation
Removal Date Place Removed
F and/or and/or Held
N Hold Address
0
Cl. Date Point of
(/)ElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
ElReinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Otherthan Above
5 Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2021 Registrar of Vital Statistics 4QvGsrt.,Ynarrorra tis(Flsctrnnrigkfy SWnsa)
/signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: —�
Date of Disposition 5,11- aa Place of Disposition o?t QttoNc<e,R. CittcanCI.,L s N 1a$t;4
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2 (address)
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ilk / /otnu\tuber/ (gra re number)
8 Name of Sexton or Person in Charge of Premise a'Nni C CLO \(l .A"
Z p/�� n (please print/,
W Signature / 1 ti rG s Title SL�eJ�'1 nem�
DOH 1555(07/18)p1of2
Public Health Law Sec. 4145(2b)
012912
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the funeral home named on burial permit
'Official Funeral Directors Reg.or License#
DENTON I LF
NAME William W Denton Sr Age: 79 \
Lot Owner: DENTON WGF
Lot# WGF Grave#
Case: Concrete
Died: 1 2/21 /21 Interred:5/1 1 /2 2
Funeral Home: Regan Denny Stafford
Cemetery: West Glens Falls
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Deed # Date
Cost Foundation Y - N
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