Kenny, William Henry -11. 5II
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Henry Kenny Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/25/2022 74 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 3835 State Route 4, Kingsbury Town, New York 12839
111
tp Manner of Death Natural Cause Accident Homicide Suicide 1Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 13
Burial Date Cemetery,Crematory or Facility Name
06/27/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
d Date Point of
(I) Transportation
by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
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
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/27/2022 Registrar of Vital Statistics Cynthia Bardin(ECectronica1TySigned)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition (p/Z$(Z� Place of Disposition
2 (ad Tess)
W
CC (section) /lotnu r) (grave number)
Name of Sexton or Person in Charge of remises
Z ^ (please print)
W Signature Title rr,
,fret
DOH-1555(07/18)p 1 of 2
. •
016018
Public Health Law Sec. 4145(2b)
Receipt
•
Human remains of delivered on , 20
•
Pine View Cemetery Representing the funeral home name on burial permit
Official Funeral Directors Reg.or License#