Wood, Michelle Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michelle Elizabeth Wood --7Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/09/2020 54 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ® Natural Cause Accident Homicide Suicide ❑Undetermined Pending
tL Circumstances Investigation
U
W Medical Certifier Name Title
0 William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 72
❑Burial Date Cemetery,Crematory or Facility Name
02/11/2020 Pine View Crematory
❑Entofnbment Address
Cremation Queensbury Town,New York
Donation
Z Date Place Removed
0 ❑Removal
and/or and/or Held
N
Hold Address
O
( Date Point of
V) Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
I^ Remains are Shipped,If Other than Above
2 Address
cc
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/11/2020 Registrar of Vital Statistics 4 gbertAndrew Curtis(Electronically 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:
WDate of Disposition 2 j1'Z 17,) Place of Disposition
uj (addr ss)
W
Ncc (section) llot numb (grave number)
0 Name of Sexton or Person in Charge of P emises r
Z /pleas rint
W Signature N Title Ad�O
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 3 3
Receipt
�f E rt
Human remains of delivered on ! , 20
l:
Pine View Cemetery Representing the`funeral home named on burial permit
Official Funeral Directors Reg.or License# s