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Devane, William Anthony NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Anthony Devane Male Date of Death Age If Veteran of U.S.Armed Forces, 10/01/2023 70 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing p Manner of Death ,f Undetermined Pendin El Natural Cause ElAccident El Homicide Suicide g C.) Circumstances Investigation Qin Medical Certifier Name Title Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 154 Burial Date Cemetery,Crematory or Facility Name 10/04/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation ❑Removal Date Place Removed and/or and/or Held — Hold Address 0 O. Date Point of ( Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address Q IW O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/03/2023 Registrar of Vital Statistics Caroline x((egarde Barber(ECectronica(CySigned) (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: W Date of Disposition I0'`( I Z3 Place of Disposition 3NE1/4/ J C i/ tVk' ._ 2 (address) W N (section) (lot number) (grave number) �8 l � I k"Name of Sexton or Person in Charge of Pre 'ses '1 n. Z lease print) W Signature Title � � DOH-1555(07/18)p 1 of 2 �q r il,.7 34. 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#