Wood, Leila # to le
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ' ' Burial - Transit Permit
' Name First Middle Last Sex
Leila Wood Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 24,2018 99 War or Dates
' Place of Death Hospital, Institution or
3° City, Town or Village Thurman Street Address 536 Mud St.
Manner of Death I XI Natural Cause I I Accident Homicide Suicide Undetermined Pending
I Circumstances Investigation
W° Medical Certifier Name Title
®= Kate Saur Jones MD
Address
Warrensburg,NY 12853
Death Certificate Filed District Number Regis}�r N mber
City, Town or Village Thurman 5659 O
❑Burial Date Cemetery or Crematory
ID Entombment August 28,2018 Pine View Crematory
Address
ID Cremation Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZZ' Removal and/or Held
and/or Address
F- Hold
N
0 Date Point of
N I I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
I 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
Remains ar= shipped, If Other than ove
Address
Cl:IX
-ermi 'sion is hereby granted to dispose of the human remain scribed above dicated.
Date Issue Registrar of Vital Statistics
( ^nat e)
District Number 5659 Place T/O Thurman,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition g'ZS ltf Place of Disposition PkA),,,-f tfitM170r'�
W (address)
0 0 (section) nj �(lotnumber) / (grave number)
0 Name of Sexton or Person in Charge of Premises l r„ " J�h4
Z t
Z (pl ase print)
Signaturea 1,_. Title trf INO&
(over)
DOH-1555 (02/2004)