Woodruff, Harold NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Mi Name First Middle Last Sex
Harold................... George Woodruff Male
iiiini Date of Death Age If Veteran of U.S.Armed Forces,
..>.',, 12-29-89. 87 War or Dates No
Place of Death :: Hospital, Institution or
<j City,Town or VillageStreet Address
gG1ens.::Falls, NYGlens Falls Hospital Glens Falls NY
Cause of Death
u Medical Certifier Name Title
G John E?.:::::Cunningham rID.:::::::.::..:............................................................................ ................._...........
Address . ...............................................................................................................::.:::::::::::.
iM
90 South St.:,....:Glens Falls,:::NY.::::12801:::::::::::::::.
Death Certificate Filed Distri........................
t Number Register Number
lil City,Town or Village Glens Falls 5601 4 1 7
Date Cemetery or Crematory
❑Burial 1-2-90 Pine View Crematorium
;:.....:...............:..:....:..............:::...:................::::::..:........... ........... ..
Address �...:........:.......:..:.::::::::::.:.......::::::::::.::...:::........:.:.::::.:::...::.........::::::::::::.....:...........:::.........:::::
..: I]Cremation
..........::.Q..0 btu'..,...NY....12804........................::......:::......::::::............:::...................................................---..........._...........................................
Z Date Place Removed
O ❑ Removal and/or Held
and/or Hold •.......::::::::::::::::......-------••::...........::::::::::::::::::::::......::::::::::::::::::::::••...........::::::•••••....
r" Address
'I)
....................................... .......... ............. _...._............_.....__.................__........_............_.._...._........_......
R.. Date Point of..................................................................................................:.....::...................:.
v) ❑Transportation by':
Shipment
O Common Carrier .....................................................................................................................................................................................................
::::::::::::::::::::::::.................................................;...................................................................................................................................................
Destination
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❑ Disinterment Date Cemetery Address
ii
❑ Reinterment
Date :: Cemetery Address
f< Permit Issued to - ` Registration Number
Name of Funeral Firm
iiiiii Address
. ,„,,,, ,of ,/..,.?..A. ...
am of Fun ral' - in i sill or to om
j Remains are ped, If Other than Above
pG::::::: :::::::....::::.
::::::.. ......................................................................................................... ...............................................................................................................
`ul
Address
t :
Permission is hereby granted to dispose of the hum remains scribed a ye as Indicated.
Mii Date Issued r `�/ '''� - 9f Registrar of Vital Statistics � �� �e
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District Number di)/ PlaceW..e,....,_ / "/" /1 /
I certify that the remains of the decedent identified above were disposed of in :"..rdance with this permit on:
Z Date of Disposition frot— /e Place of Disposition ,",'A c1f'.cL) f 4 E/Yfj9/O,8/rv/f
LU
2 (address)
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1= (section) (lot number) (grave number)
pi Name of Sexton Person i Charge of Pre ises �P�` /l �/,9 %/f 9//"
Z (please print) r -
W Signature /�Q-uJ� �7 Title I�/1 i6-/i /CJ/y /t? ",5-7,5-/ A
DOH-1555 (9/86)p 1 of 2(formerly VS-61)