Woodard, Terry NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Terry Lee Woodard Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/19/2017 61 Years War or Dates 1973
F- Place of Death Hospital, Institution or
• City, Town or Village Glens Fallsill Street Address Glens Falls Hospital
O Manner of Death ruliAi Natural Cause 0 Accident El Homicide Ei Suicide riUndetermined ri Pending
Circumstances Investigation
w Medical Certifier Name Title
d William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 498
❑Burial Date Cemetery or Crematory
09/21/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
0 Date Point of
%0 Transportation Shipment
• by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
.Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
IF Remains are Shipped, If Other than Above
S Address
Ct
W
13"' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/21/2017 Registrar of Vital Statistics xthertACurtis E&ctronicaaySullied
(signature)
District Number 5601 Place Glens Falls, New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition y in ill Place of Disposition niJ+ ( }a^^
W (address)
Eli'
W (section) l(lot number) (� (grave number)
pName of Sexton or Person in Charge of Pr mises t kn.4"jr ✓6r4 elf
z (plea print)lil r
Signature 4 Title lEM
(over)
DOH-1555(02/2004)