Wight, Wendy Ann NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Wendy Ann Wight I Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2019 77 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Mannerof Death 0 Natural Cause Accident Homicide ❑Suicide Undetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 106
Burial Date Cemetery,Crematory or Facility Name
12/19/2019 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
El Donation
OZ Removal Date Place Removed
and/or and/or Held
i-N Hold Address `
O
Q. Date Point of
(a ❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
i
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
Address
cc
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 1 2/1 912 01 9 Registrar of Vital Statistics f7irneeMalraney(EYectronicalTy Signed)
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition Place of Disposition
W (address)
2
W
(section) (lot number/ (grave number)
G Name of Sexton or Person in Charge of Premises
(Please print)Z
W Signature Title
DO H-1555(o7/18)p 1 of 2
12/19/2019 91:39 51B7477548 MBKILMER PAGE 81
ii
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Wendy Ann Wight Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/1612019 77 Years War or Dales
Place of Death Hospital Institution or
IZ City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Carrie Miron PA
Address
319 Broadway,Fort Edwaro Town,Now York 12828
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 108
Burial Date Cemetery,Crematory or Facility Name
12119/2019 Pine view Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
Date Place Removed
QRemoval and/or and/or Held
Hold Address
Date Point of
y ❑Transportation Shipment
a by Common
Carrier Destination
Date Cemetery Address
LlDisinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of funeral Home MR Kllmer Funeral Home-Fort Edward 01 D79
Address
B2 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,'ff Other than Above
2 Address
1U
n' Permission Is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 12119/2019 Registrar of Vital Statistics (1rNt6Ma/Fnrr6y(�ledrorJiCa!ly,JfyarJ)
/sigwaNnl
�I
District Number 5755 Place Fort Edward. New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ���1 Place of Disposition l"-J ; cn
lAJ (� /
W
N /ierraaa/ /l01 number/ (gii►r number/
W. A yrno� d
Name of Sexton or Person in harge of P ises
/p/ius prMr/
W Signature Title
DOH•i555 lu7/18)p 1012
- a
Public Health Law Sec. 4145(2b) ,
03-3163
Receipt
Human remains of delivered on , Zp
l
Pine View Cemetery Representing the fuAerAl home named qn burial pecnIit
Official Funeral Directors Reg.or License#