Wood, Herbert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
-'3> Herbert W. Wood Male
ax Date of Death Age If Veteran of U.S. Armed Forces,
July 2,2018 72 War or Dates
i."° Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 11 Skylark Lane
Ilk
Manner of Death g Natural Cause Accident Homicide Suicide Undetermined Pending
Akt Circumstances Investigation
Ark i Medical Certifier Name Title
5 Darci Ann Gaiotti-Grubbs MD
,. Address
` ;: 102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
: = City, Town or Village Warrensburg 5660 `/
❑Burial Date Cemetery or Crematory
July 3,2018 Pine View Crematory
❑Entombment Address
❑X Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
1_ Hold
U)
0 Date Point of
g;I I Transportation Shipment
a 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
'''-I Address
e 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
' w Remains are Shipped, If Other than Above
Address
Ur
CL= Permission is hereby granted to dispose of the humAur mails des ibe above as indicated.
Date Issued 7-3-18 Registrar of Vital StatOcG�"---
/ (signature)
District Number / 6 Place T/O Warrensburg,NY
,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ui Date of Disposition 111,t1T Place of Disposition {?,4,- ��,4.-..
W (address)
co
cc
(section) (lot numbe / ( (grave number)
G Name of Sexton or Person in Charge of Premises il�n.�pL SL-
Z (please print) 1
Signature Title 1404'(i t
(over)
DOH-1555 (02/2004)