Bollinger, William 41111i
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Bollinger Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/30/2022 78 Years W ar o r Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
Mannerof Death aNaturalCause DAccident 0Homicide OSuicide ❑Undetermined ❑Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or VillageEl
5601 447
Burial Date Cemetery,Crematory or Facility Name
Addre2022 Pine View Crematory
Entombment Address
Cremation Queensbuty Town,New York
DDonation
Removal Date Place Removed
• and/or and/or Held
N
Hold Address
O Date Point of
U)▪ ❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
D Re interment
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
S Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/01/2022 Registrar of Vital Statistics A/vanNoSts(Elsct nnuk4Q S&n'O
(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 1 I Z lit Place of Disposition a` r-iror•
2 (era e331
W
N
cr (section) /A (lot number) (gca renumber)
gName of Sexton or Person in Charge of Pre ises L A ni tvL tt
z (p ase print/
UJ Signature 7" // r' litle r ffMHTV4
DOH 1555(07/18)p 1 of 2
0 1 E.;2 k)5
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#