Bachert,William Robert , _\r(i, 4- 510 g
NEW YORK STATE DEPARTMENT OF HEALTH /
Bureau of Vital Records / Burial - Transit Permit
Name First Middle Last Sex
William Robert Bachert Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/14/2022 75 Years War or Dates 1965-1968
F Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death 0 Natural Cause Accident ❑Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Shannon Kennedy NP
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1658
Burial Date Cemetery,Crematory or Facility Name
R07/19/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
IIIDonation
Removal Date Place Removed
and/or and/or Held 0 j
F Hold Address
N
0
t1 Date Point of
U)❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
IllReinterment 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
1— Remains are Shipped,If Other than Above
2 Address
CC
LU
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/18/2022 Registrar of Vital Statistics (DanieQe S Gittespie(ECectronica1TySigned)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 1 I'i9 1 U. Place of Disposition 't t„ Vj� �
� , ZY"...—
2 (address)
W
N (section) /J (lot number) StAkettt
(grave number)
� d//Ili c8 Name of Sexton or Personin Char of Premisesf ! e riot)
(P P
W Signature i` c— Title r MWM-
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
ial Funeral Directors Reg.or License# Of