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Smith, William Gregory
(LF j3c NEW YORK STATE DEPARTMENT OF HEALTH ��Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex William Gregory Smith Male Date of Death Age If Veteran of U.S.Armed Forces, 01/05/2024 82 Years War or Dates 1963-65 f_ Place of Death Hospital,Institution or WCity,Town or Village Colonie Town Street Address 7 Bethwood Drive,Colonie Town,New York 12211 p Manner of Death Z Natural Cause EAccident Homicide ESuicide Undetermined ❑Pending UCircumstances Investigation ILI 0 Medical Certifier Name Title Yassah Sim NP Address 43 New Scotland Avenue MC7,Albany,New York 12203 Death Certificate Filed Town Of Colonie District Number Register Number City,Town or Village 0153 4 Burial Date Cemetery,Crematory or Facility Name IN' 01/09/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 Cl- Date Point of U)OTransportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2024 Registrar of Vital Statistics Juliet Gans(e(E(ectronica((ySigned) (signature) District Number 0153 Place Town Of Colonie I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ih- W uyc�Date of Disposition I Eli 124 Place of Disposition j'i#►€ 1 11iP-.kur., 2 (address) W CC (section) 4 (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises 7_!e r'° �' Qr�MZ /Prise print/WSignature Title fef144-rott. 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#