Woodcock, Kenneth 4 * /
NEW YORK STATE DEPARTMENT OF HEALTH MI6
Vital Records Section Burial - Transit Lermit
Name First Middle Last Sex
in
Kenneth Woodcock Male
`' Date of Death Age If Veteran of U.S. Armed Forces,
02 / 20 / 2017 62 War or Dates N/A
14 Place of Death Hospital, Institution or
City, Town or ViJJage Schuylerville Street Address
Manner of Death
®Natural Cause Ei Accident El Homicide El Suicide �Undetermined �Pending
itil Circumstances Investigation
111 Medical Certifier Name Title
0 Rachid Daoui MD
Address
6 Care Ln, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
Mi City,Town or Village Schuylerville
S fBurial Date Cemetery or Crematory
02 / 24 / 2017 Pine View Crematory
`' s 0Entombment Address
< °ECremation Queensbury, NY
Date Place Removed
4❑Removal and/or Held
..- and/or Address
Hold
VD
Date Point of
1 ID Transportation Shipment
by Common Destination
IiW Carrier
_' Q Disinterment
Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
. Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z Address
IC
114
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued cJ a;j .oi 7 Registrar of Vital Statistics (, 71' G
fiII
NI (signature)
igl': District Number 43(05 Place -ram 04 Scucav3 ` New York
#y I certify that the remains of the decedent identified above were disposed
of in accordance with this permit on:
Z
tAi Date of Disposition 2125 1 n Place of Disposition Ill I,) (..i.r or),,..
address)
fili
CC (section) 1,1 (lot number) (grave number)
aName of Sexton or Person in Charge of Premises ��r,s is— S1r4th
Z (pl ase print) .
t Signature /� Title 04 WiPitlR
(over)
DOH-1555 (02/2004)