Wells, William Byrum NEW YORK STATE DEPARTMENT OF HEAL -)OZ
TH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Byrum Wells Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/25/2022 65 Years War or Dates 1978-1984
F. Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 425 Glen Street 41,Glens Falls,New York 12801
p Manner of Death JJ Natural Cause Accident 1=1 Homicide OSuicide Undetermined riPending
W U Circumstances Investigation
WQ Medical Certifier Name Title
Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 451
Burial Date Cemetery,Crematory or Facility Name
09/01/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
EiDonation
Date Place Removed
❑Removal
F. and/or and/or Held
N Hold Address
0
O. Date Point of
(I) Transportation
p by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
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
H Remains are Shipped,If Other than Above
- Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/01/2022 Registrar of Vital Statistics Megan Wolin(E(ectronicallySigned)
(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 l i Z i Z Z Place of Disposition r�,�
2 (address)
W
CC N (section) (lot number) (grave number)
SName of Sexton or Person in Charge o emises P16 te 4
Z (p/ se print)
W Signature Title � �IW2
DOH-1555(07/18)pi of 2
fl
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery - Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#