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Fuller, William Charles Jr.
13 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Charles Fuller Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 03/05/2023 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing W Manner of Death Undetermined Pendin O Natural Cause Accident Homicide Ei Suicide g W Circumstances Investigation W Medical Certifier Name Title CI Joshua Started NP Address 17 Madison St,Granville Village,New York 12832 Death Certificate Filed Village Of Granville District Number Register Number City,Town or Village 5725 11 Burial Date Cemetery,Crematory or Facility Name 03/06/2023 Pine View Crematory Entergbupent - Address ©Cremation Queensbury Town,New York ElDonation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address O O. Date Point of U)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway, Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— 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 03/06/2023 Registrar of Vital Statistics Diana Scarlotta(Electronically Signed) (signature) District Number 5725 Place Village Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— Z Date of Disposition 3/$113 Place of Disposition �tu� 2 (address) W CC N (section) (lot number) (grave number) • Name of Sexton or Person in Charge of Pre ises ^ L.. It please print) Z W Signature Title ° "� �� DOH-1555(07/18)p 1 of 2 & e 1 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#