Wilson, Joyace 33 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joyace Wilson Female
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 08 / 2017 74 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death LE Natural Cause [�Accident 0 Homicide 0Suicide 0 Undetermined E Pending
ILICircumstances Investigation
LI-
tu Medical Certifier Name Title
Ct Sadra Azizi-Ghannad MD
Address
100 Park St., Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls
�BUrlal Date Cemetery or Crematory
07 / 17 / 2017 Pine View Crematory
rjEntombment Address
iigECremation Queenebury, NY
Date Place Removed
Removal and/or Held
and/or Address
Hold
V. Date Point of
0 Transportation Shipment
;5 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
i
`€ Permit Issued to Registration Number
0.1 Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
iliiiii!I Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Z
IL
Permission is hereby granted to dispose of the human remains described above.as indicated.
Date Issued -7)( 7/(-? Registrar of Vital Statistics '-'-.J-r V )..A✓`
(signature)
i District Number 56 0 , Place Glens Falls , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lit Date of Disposition 7/2,0"7 Place of Disposition Pr,�1Q 11 r CLJ C_re40aA'
(address)
0
IC (section) _
0 \ (/ i'i(lot tuber) (grave number)
C Name of Sexton or P r n- Charge of Premises —lam- ' ' 6 4 e-
at (please print) -
Signature Title C, )/
(over)
DOH-1555 (02/2004)