Wright, Charles NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vitai Ripcords Section
Name First Middle Last Sex
Charles H. Wright Male .
Date of Death Age If Veteran of U.S.Armed Forces,
1- December 10. 2006 93 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
0 Manner of Death El Natural Cause Ej Accident D Homicide EISuicide n Undetermined El Pending
W Circumstances Investigation
Q Medical Certifier Name Title
W Dr. Amy Moulton-Hogan, M.D. Dr.
0 Address
2 Broad St. Plaza, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls ,5-6 p/ o=t,/
r-� Date Cemetery or Crematory
i IBurial December 16, 2006 Pine View Cemetery
Address
1 El Cremation Quaker Rd. Oueensburv, NY 12804-
Date Place Removed
0 0 Removal and/or Held
- and/or Address
• Hold
11) Date Point of
0 El Transportation Shipment
d by Common Destination
0 Carrier
Date Cemetery Address
o ❑ Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00283
Address
I-
68 Main St., P. 0. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
8: Remains are Shipped, If Other than Above
w Address
O.
Permission is hereby granted to dispose of the human remains desc dj�lit Indic 07
4._
Date Issued /-2-/Z.—tom Registrar of Vital Statistics
(signature)
District Number c56,o/ _ Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 12/16/0 6 Place of Dispositic?i I NE VIEW CEMETERY, Q U E E E N S B U R Y NY
E (address)
yr HUDSON #1 12-B 1
0 0 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises M I C HA E L GENIE R
z (please print)
W
Signature Title S U P T .