Hart, William Joseph 7
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NEW YORK STATE DEPARTMENT OF HEALTH \ i Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Jospeh Hart Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/01/2023 93 Years War or Dates
p Place of Death
Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause Accident ❑Homicide D Suicide Undetermined nPending
W
C.) Circumstances II ''Investigation
W Medical Certifier Name Title
0 Marvin Davidowitz 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 001
Burial Date Cemetery,Crematory or Facility Name
01/03/2023 Pine View Crematory
IllEntombment Address
Cremation Queensbury Town,New York
LiiDonation
Date Place Removed
0 El Removal and/or Held
F- and/or
N
Hold Address
0
Date Point of
U)0Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped,If Other than Above .
N Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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:
W Date of Disposition f f I 11,3 Place of Disposition / �/
W
CC (section) /(!ot number) (grave number)
Person in Char f Premises �9L -C ),:vvi 1
0 Name of Sexton or (pleat print)Z ri7e- Ylti�e'
MI Signature Title
DOH-1555(07/18)p tar 2
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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#