Wood, Ronald NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
Ronald I. Wood Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 25,2017 66 War or Dates
cPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of DeathUndetermined Pending
� X Natural Cause Accident I �Homicide Suicide
,t11 Circumstances Investigation
ut Medical Certifier Name Title
Darci Ann Gaiotti-Grubbs
Address
''_ 102 Park St.
Death Certificate Filed District Number Register Number
City, Town or Village 5 60 / j CI 2
❑Burial Date Cemetery or Crematory
March 27,2017 Pine View Crematory
0 Entombment Address
®Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
O.
Transportation Shipment
p 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 00035
Address
, 3809 Main Street,Warrensburg,NY 12885
, Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
2. Address
It
LEI
' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 312-7 1( 7 Registrar of Vital Statistics W C .,ry. .. W
(signet re)
District Number 5 t,Q r Place C Cs2n,.S 5.k S ,N y'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 2 Place of Disposition fi�� yf�C,J _7 4:�/r/'y
W (address)
U)
0 (section) l ff (lot gumber) (grave number)
pName of Sexton or P rson in Charge of Premises ,.J <i G,.v? C� .r1't4.4-4—e
Z (please print)
W Signature t Title C-,-2:-n4 �,,/..-
(over)
DOH-1555 (02/2004)