Woodcock, Hazel $t3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit PermitVital Records Section
Name First Middle Last Sex
Hazel Woodcock Female
Date of Death Age If Veteran of U.S. Armed Forces,
10 / 18 / 2018 92 War or Dates N/A
#- Place of Death Hospital, Institution or
City, Town or Village Corinth Street Address 3 Spruce Mountain Road
0 Manner of Death r Natural Cause Accident Homicide 0 Suicide �Undetermined �Pending
Circumstances Investigation
tu Medical Certifier Name Title
Susan S. Dorsey MD
Address
1 West Ave, Saratoga Springs, NY 12866
s Death Certificate Filed District Number -I 50 Register Nul r
Pi City, Town or Village Corinth
>< Burial Date Cemetery or Crematory
10 / 19 / 2018 Pine View Crematory
Mi 0Entombment Address
ECremation Queensbury, NY
;..> Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
Date Point of
3 f
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
iiiii
i Q Reinterment Date Cemetery Address
Permit Issued to 1 Registration Number
El Name of Funeral Home Compassionate Funeral Abe 00364
Address
El 402 Maple Ave., Saratoga Sp. , NY 12866
iiiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ir
ILI
Permission is hereby ranted to dispose of the human re scribed a ov a ' dic d.
`! Date Issued f 0 /'9 ni Registrar of Vital Statistics
// (sig re)
+< District Number "" Place Corinth , New York
'` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
#-
Z.
W Date of Disposition /0'ZL II$ Place of Disposition �,,\ ..e �„ —
(address)
ILI
CC (section) (lot tuber) (grave number)
0 Name of Sexton or Person ill Charge of Pr mises L&': S'`"�
, ► (please Tint) •
i Signature 11 y, Title / fl
Q
(over)
DOH-1555 (02/2004)