Wright, Grant s i��
NEW YORK STATE DEPARTMENT OF HEALTH �Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Grant Carl Wright Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 30,2018 93 War or Dates WWII
'.° Place of Death Hospital, Institution or
: City, Town or Village Milton Street Address Pine Manor
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
ut Medical Certifier Name Title
1 Reeves Dr.
Address
•
Iron Gate Center,Glens Falls,NY 12801
Death Certificate Filed District Number 45j 1 Register Number ��
City, Town or Village �7
❑Burial Date Cemetery or Crematory
February 1,2018 Pine View Crematory
0 Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
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O Date Point of
N n Transportation Shipment
p by Common Destination
Carrier
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 Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
r. Remains are Shipped, If Other than Above
E Address
f!
ti3
Q. Permission is hereby granted to dispose of the human r ins described-abbe as indicated. \
Date Issued I I 1 (-3 Registrar of Vital Statistics
(signa ure)
District Number p ( Place et-C \ ",. \, n
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition II t lig Place of Disposition f;,,O� 12.-ok-
2 (address)
W
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ce (section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Pr ises g„tiet.— ) ,,n44
Z // (pease print)
W Signature h /Z�-„+- Title febo
g , , rj t�!1
(over)
DOH-1555 (02/2004)