Loading...
Wyant, Edward NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section . - Burial - Transit Permit Name First Middle Alit Last Sex Edward Eugene Wyant Male Date of Death Age If Veteran of U.S.Armed Forces, June 7,2006 79 War or Dates World War II H Place of Death Town ofJohnsburg Hospital, Institution or Z City,Town or Village Street Address W Manner of Death © Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending G Circumstances Investigation a Medical Certifier Name Title Wel ANWOMpla James Hicks Physician Address HIIHN,North Creek,NY 12853- Death Certificate Filed District Number Register Number City,Town or Village Town of Johnsburg 5655 24 El Burial Date Cemetery or Crematory 6/8/2006 Pine View Crematorium ❑ Entombment Address © Cremation Queensbury,NY Date Place Removed z ❑ Removal and/or Held p and/or Address H Hold 73 Date Point of a ❑ Transportation Shipment N by Common Destination 0 Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Alexander Funeral Home,Inc. 00037 Address 4479 State Route 28,North River,NY 12856 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped, If Other than Above - Address tY dPermission is hereby granted to dispose of the human remaind esscribed a Wye ndicated. Date Issued 06 08 2006 Registrar of Vital Statistics �� �.� R-i-- C� (signature) District Number 5655 Place Town ofJohnsburg,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition It— y-ort! Place of Disposition r 1 1`)E-E // iL. cAz ..r,i, Ka (i'27 (address) 2 W cn (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises G- v4 f-` ' R,i G (please print) W Signature c2..t.'� , :.,q Title R 1 i`� 0�� DOH-1555(02/2004) (over)