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Wise, William A
NEW YORK STATE DEPARTMENT OF H EALTH Burial Bureau of Vital Records - Transit Permit Name First Middle Last Sex William A.Wise Male Date of Death Age If Veteran of U.S.Armed Forces, 06/12/2023 78 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital (3 Manner of Death El Natural Cause []Accident 0 Homicide Suicide IllUndetermined ri Pending 111 Circumstances Investigation LU Medical Certifier Name Title Gwendolyn Morris-Dickinson PA 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 298 Burial Date Cemetery,Crematory or Facility Name 06/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York EiDonation o❑Removal Date Place Removed and/or and/or Held N N Hold Address 0 d Date Point of U)❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/14/2023 Registrar of Vital Statistics Megan Wain(ECectronica1Ty 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: Z W Date of Disposition 4 hs I Z; Place of Disposition 2 (address) W CC N (section) 4 (lot number) (grave number) gName of Sexton or Person in Charge o miser [] &n% t Z ease print/ /� W Signature Title l � DOH-1555(07/18)p 1 of 2 1 U `E Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 f f ,. Pine View Cemetery-'' Representing the funeral'home named on.13 -ial.permit Official Funeral Directors Reg.or License# "`