Woodcock Jr., Russell Ernest NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records -�`r
Burial - Transit Permif
Name First Middle Last Sex
Russell Ernest Woodcock Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/15/2020 70 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
W
p Manner of Death 0 Natural Cause Accident Homicide Suicide ❑ Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Edit Masaba MI)
Address
4573 State Route 40,Argyle Town, New York 12809
rDea,tlT Certificate Filed District Number Register Number
own or Village Argyle 5750 15
❑Burial Date Cemetery,Crematory or Facility Name
04/15/2020 Pine View Crematory
Entombment Address
RI Cremation Queensbury Town, New York
❑Donation
OZ Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
IL Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
h Remains are Shipped,If Other than Above
Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/15/2020 Registrar of Vital Statistics ShelleyMckernon(Ek tronica11ySy-,4
(signature)
District Number 5750 Place Argyle, 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 10 Place of Disposition t`--
W
2 (address)
W
N
Ilr (section) (lot number), (grave number)
Name of Sexton or Person in Charge Premises
Z / ase print
W Signature Titled
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) " 01354e
0
Receipt
Human remains of delivered on 120
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#