Wicks, Deniece NEW ORK g' TATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Deniece Luella Wicks F
Date of Death 0 6/0 6/2 01 4 81 Age If Veteran of U.S. Armed Forces,
War or Dates
}-• Place of Death Hospital, Institution or
W City, Town or Village Queensbury Street Address 644 West Mountain Road
Manner of Death 0 Natural Cause 0 Accident Homicide 0 Suicide Undetermined Pending
W Circumstances Investigation
III Medical Certifier Name Title
CI Elizabeth Hutchins NP
Address 2 Broad St. Plaza Glens Falls,NY 12801
Death Certificate Filed District Number ism Number
City, Town or Village Queensbury S Loc-'li S
[Burial Date Cemetery or Crematory
06/09/2014 Pineview Cemetery
Entombment Address
❑Cremation 21 Quaker Road Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
2❑and/or Address�
Hold
tel
0 Date Point of
oi❑Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home MB Kilmer Funeral Home 01-078
Address
136 Main Street South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
CC
Ili
.fa! Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued (.,p( '° 160t1/4-, Registrar of Vital Statistics 'Kc--.... Q CAS Li__
(signature)
District NumIC(9 C ) Plac 7 ,,___,„. d-C C _ ,�
> I certify that the remains of the decedent identified above were disposed of in acco an a with this permit on:
ILI Date of Disposition 6/6/1 4 Place of Disposition Pine View Cemetery
2 (address)
Iti Huron 8A 2
Mti
CC (section) (lot number) (grave number)
0
ci Name of S ton or Person in Charge of Premises
Connie L. Goedert
ea a ri
SupePiefi Siln e n t
Signatu Title
(over)
DOH-1555 (02/2004)
WICKS
Lot No. 8-A
Address 644 West Mountain Rd . , Queensbury ,NY 12804 Section No.
Owner Walter & Deniece Wicks Plot
Huron
hAV( C.KS 326 -`13641-
Date 8/4/97
Approx. 67 Superficial ft.
Location Bounded on North by Vacant , East by Wicks , South by Trees ,
West bt Gans e ._
corner Posts
temarks
)eed No. (and changes) 2827
'ayment Record Paid in Full 8/4/97 ( $700 . 00 )
tecord of Interments 6
611zN
) ' k-Ljt/(a‘o
1 )e,K,i �� li� tA ( c:Q 19 14 ) 75 'W l a to .l
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17 , C2rc •
Form No. 01
NAME WICKS, DENIECE LUELLA LF
Age: 81
Cause: Natural
Lot Owner: Walter & Luella Wicks
Lot # 8 A Huron
Grave # 2
Case # Concrete
Died: 6/6/2014
Interred: 6/9/2014
Undertaker: MB Kilmer