Woodard, Deborah t , '
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
..r".- Name First Middle Last Sex
Deborah Ann Woodard Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/04/2018 62 Years War or Dates
at Place of Death Hospital, Institution or
'Az City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death irE Natural Cause 0 Accident Ei Homicide El Suicide El Undetermined El Pending
"'Circumstances Investigation
Medical Certifier Name Title
Paul Bachman MD
Address
, 100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
,, City, Town or Village Glens Falls 5601 8
t rtin
tia,,i Burial Date Cemetery or Crematory
01/10/2018 Pine View Cemetery
0 Entombment Address
OCremation Queensbury Town, New York
Date Place Removed
t ri Removal and/or Held
I'and/or Address
.60.0. Hold
Date Point of
El Transportation Shipment
by Common Destination
' Carrier
, Disinterment
___, Date Cemetery Address
11
Reinterment Date Cemetery Address
0
01 Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
,, 68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
tz Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
. ,
Date Issued 01/08/2018 Registrar of Vital Statistics Robert_A Curtis((Eactronicaffy Signed)
(signature)
District Number 5601 Place Glens Falls. New York
.._ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
a
44 .,,, ,
ill Date of Disposition / /6(2.1W g Place of Disposition 41 L'iltik.Li iesd• &/,(as/Mal
a , (address)
40\-u C_Cryl 42- b. 1
ili, on) (lot number) (grave number)
1 Name of Se n or Person in Charge of Premises - tOiC- L. ( Eler
iMA.t, g.15-g-1-14(
Signatur Title elAtibui Sly-b./AA e4(
,.
(over)
DOH-1555 (02/2004)