Berry, Wendy NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last. Sex
Wendy Ann Berry Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/22/2018 49 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death yj Natural Cause ❑Accident Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
tt City, Town or Village Glens Falls 5601 403
0 Burial Date Cemetery or Crematory
08/27/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carder
ID Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
r. Name of Funeral Home Maynard D Baker Funeral Home 01130
a Address
11 Lafayette St,Queensbury,New York 12804
K. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
( Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/24/2018 Registrar of Vital Statistics W96ertA Curtis(E(ectronically Signed)
(signature)
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:
Date of Disposition E'1'j 11y Place of Disposition eft ki-w •••-}6.--
(address
(section) (lot n giber) (grave number)
Name of Sexton or Person in Charge of Prem'ses 384 *
✓ (please Pri►ft)
Signature Title liKAA Nt.
(over)
DOH-1555 (02/2004)