Ward, Thomas William #
(17F)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
53
Bureau of Vital Records
Name First Middle Last Sex
Thomas William Ward Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/03/2022 71 Years War or Dates
1— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
Wp Manner of Death II Natural Cause Accident 0 Homicide ESuicide Undetermined Pending
iW Circumstances Investigation
W Medical Certifier Name Title
a Shahid Ahmed MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 355
EiBurial Date Cemetery,Crematory or Facility Name
07/06/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
KnRemoval Date Place Removed
E and/or and/or Held
N Hold Address
0
Transportation Date Point of
b by Common Shipment
Carrier Destination
Date Cemetery Address
❑DisintermentO
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
2 Address
EC
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/06/2022 Registrar of Vital Statistics Megan Wolin OctronicaffySigned)
(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:
WDate of Disposition 7I )12Z Place of Disposition s
4----
2 (address)
iW
(section) d plot number/)si, (grave number)
Name of Sexton or Person in Charge of Pr mises
z
z Weise print
iW Signature Title fwAtiN�/-
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1.7 1'
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#