Wofford, Patricia fl 7r
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia E Wofford
Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/26/2018 70 Years War or Dates
x` Place of Death Hospital, Institution or
fiii City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Nil Manner of Death IX Natural Cause Accident Homicide Suicide Undetermined Pending
DTICircumstances Investigation
l Medical Certifier Name Title
Kenneth France MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
;,-, City, Town or Village Glens Falls 5601 50
_❑Burial Date Cemetery or Crematory
01/29/2018 Pineview Crematory
:i❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
r5;
Date Point of
- ❑Transportation Shipment
by Common Destination
y Carrier
❑Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
- Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
. _� Remains are Shipped, If Other than Above
Address
`A t
61
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/29/2018 Registrar of Vital Statistics cgbertA Curtis(ECectronicallySigned)
(signature)
n District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
RI ®uJ. p
Date of Disposition //Z ill Place of Disposition 1r ' [...,fti --
t (address)
Z
VI (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premis
c.,..461-
( se print)
Signature 14 Title /k y"/I R'Z
(over)
DOH-1555(02/2004)