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Augusta, William -It c NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Augusta Male Date of Death Age If Veteran of U.S.Armed Forces, 10/16/2023 53 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death Natural Cause EAccident El Homicide Suicide Undetermined n Pending UCircumstances L Investigation Wa Medical Certifier Name Title Melia Wakeman MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 2476 Burial Date Cemetery,Crematory or Facility Name 10/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or Held and/or N Hold Address 0 a. Date Point of N Transportation p 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 F Remains are Shipped,If Other than Above 2 Address CC 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 Kjny Bartfio(omew(E(ectronica((y Signed) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /12-2/-Zee 3 Place of Disposition if:e,,t)ILI (address) W 0 (section) // (lot nu nber) (grave number) 0 Name of Sexton or Person in Charg f Pr mi s r/Ybn! L, Obd Z (please print) W e Signature /✓�' Title 0 re/ g 1 DOH-1555(07/18)p i of 2 ;7,1_1_ 7394 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 4 d�, Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#"`t 3