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Wallace, Howard 4-)3 )NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex VO ma Howard V.Wallace Male Date of Death Age If Veteran of U.S. Armed Forces, 10/01/2017 95 Years War or Dates 1943-1945 Place of Death Hospital, Institution or • City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident Homicide El Suicide 0 Undetermined n Pending Circumstances Investigation 1 Medical Certifier Name Title Wendy Steinhacker PA fjAddress • 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number ,, City,Town or Village Glens Falls 5601 508 St❑Burial Date Cemetery or Crematory 10/02/2017 Pine View Crematorium or[]Entombment Address ®Cremation Queensbury Hamlet, New York to Date Place Removed ❑Removal and/or Address and/or Held Hold , Date Point of r44 w Li Transportation Shipment Tit by Common Destination Xii Carrier Q Disinterment Date Cemetery Address 10 [�Reinterment Date Cemetery Address 14• Permit Issued to Registration Number itts Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 titi Address 9 Pine St,Chestertown,New York 12817 il Name of Funeral Firm Making Disposition or to Whom a Remains are Shipped, If Other than Above Address 44. 14-4 Permission is hereby granted to dispose of the human remains described above as indicated. to Date Issued 10/02/2017 Registrar of Vital Statistics gWertA Curtis Ekctronicalysigned rii (signature) '',i District Number 5601 Place Glens Falls, New York iftA I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: } Date of Disposition /b/31O Place of Disposition 1;1'1 ,i (ivrt,-- (address) (section) A(lot number} (grave number) Name of Sexton or Person in Charge of P mises J 9.4*t0t' (*se;wint) v. Signature � rrtiThttcy Title 4� (over) DOH-1555 (02/2004)