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Wilkinson, George NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Biostatistics -Vital Records Section Name First Middle Last i. Sex George Wilkinson male Date of De ath i Age if Veteran of U.S.Armed Forces, '>'': 2/13/1989 88 War or Dates no Place of Death Hospital, Institution or City,Town or Village ` Street Address : ....... 9 Town of Queensbury Westmount Health Facility ,,...Cause::: ..................................... ......................... ................................................................................................................................ .......................... ....... :::::::,.................................... ........................ tl] ofDeath cancer of prostate iii Medical Certifier Name Title 41 John Ec Cunningham j MD Address 90 South Street, Glens Falls, New York 12801 Death Certifioateile:::::................................................................. .. . ............................................ ................ F d District Number Register Number City,Town or Village Town of Oueensbury i. 5(o �] 0 Date Cemetery or Crematory ©Burial Pine View CemeterX....................... ❑Cremation :': Address .......:.:..:.::::...............................:.:....:::.:.:::::.:..............::...::::::.:::...:.::: Townof Queensbury,..::::N:-:Y:-.:.:.:::.:..::::::::::::: :::::::::::.....:::: .......:........_........_..........._..................... ..._......... ............... Z Date Place Removed 0 0 Removal ` and/or Held ` > Address N . Date € Point of v)I 0 Transportation by` Shipment Common Carrier Destination ................................................................................................................................................................................................................................................................................... ❑ Disinterment Date Cemetery Address DateCe meteAddress':::::................................................................................................... ElReinterment ry Permit Issued to Registration Number Ii€I Name of Funeral Firm ...::: .Regan:::and...Denny:::Funeral Service,.::::Inc„.:::::::::::::::::::::::::::::::.::::::::::::Q.288. :::::::::::::::::::. li Address 40 Quaker Road, Queensbury, N.Y. 12804 ::me.of.:Funeral Firm Making Dis::.,.sition or to Whom::::,:....................................................................................................................................................... Nam F g po j Remains are Shipped, If Other than Above 10 Address 411 iiiiiiiiii Permission is hereby granted to dispose of the human remains des bed above asash indi at d.. Date Issued IL- l Registrar of Vital Statistics CL : St _ L 2 s!J( Zs nature) District Number 1 Place ---00-1A-'Ne---M OLLC)12_,,------)J-LA- _...., I certify that the remains of the decedent identified above were di ed of in accordance with this permi o : I•- WDate of Disposition ,- 17-Si Place of Disposition P`c {.i \ c-v:-4 cc,,:^ e-c c�� Lie c iL S 1.,k, j,. , (address) J I Unlic.Itto.-- rxr- 22-j) f (section) (lot number) (grave number) pName of Sexto Person in Charge of Premises 2c, d Al F-4 G, I Yl c,r k v. L Z (please print) W Signature (please Title 5 t� 'r, DOH-1555(9/86)p 1 of 2(formerly VS-61)