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Herald, William LF 3(,_3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Herald Male Date of Death Age If Veteran of U.S.Armed Forces, 04/13/2023 64 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 253 Clendon Brook Rd,Queensbury Town,New York 12804 p Manner of Death ❑^ Natural Cause Accident El Homicide 0Suicide FlUndetermined Pending Id V Circumstances Investigation W Medical Certifier Name Title a Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 60 HBurial Date Cemetery,Crematory or Facility Name 04/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation g❑Removal Date Place Removed and/or and/or Held t— Hold Address CD O. Date Point of U)❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped,If Other than Above 2 Address Q W D. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/17/2023 Registrar of Vital Statistics Carolnexkligari BadergYectronicaf Srgttea9 (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition y L2^lc,Zj Place of Disposition ` /lf e vie-a) Cr--0-my; /`� 2 (address) W Cr (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Premis ' I�a-(ma,-,rb �,A (please print) z : �, 0 — W Signature 1 Title DOH-1555(07/18)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 Official Funeral Directors Reg.or License#