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King, William Martin • * -tt'% W NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Martin King Male Date of Death Age If Veteran of U.S.Armed Forces, 10/18/2023 63 Years War or Dates F Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death EINaturalCause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title O William Cleaver 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 489 RBurial Date Cemetery,Crematory or Facility Name 10/19/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town, New York ▪Donation Q❑Removal Date Place Removed and/or and/or Held I— (7) Hold Address 0 a Date Point of U) Transportation 8by Common Shipment Carrier Destination o Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above 5 Address I W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/19/2023 Registrar of Vital Statistics Megan Wolin(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: Z W Date of Disposition /ON tj Place of Disposition fswEowa <rwt 1 `+� •ATiRo'rJ`-� 2 (address) W N (section) 4 (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises '. L f if z E (p se print) Ili le";Title w ad DOH-1555(07/18)p 1 of 2 i k'& 1 ,3x r Public Health Law Sec. 4145(2b) Receipt Human remains of " f+ delivered on , 20 • Pine View Cemetery Representing the funeral home named on puria1,permit Official Funeral Directors Reg.or License ft�