Wood, Alan it 2(0
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section r ,• ''ik Burial - Transit Permit
Name First Middle Last Sex
Alan R. Wood Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 18,2011 66 War or Dates
1„ Place of Death Hospital, Institution or
Z City, Town or Village Street Address Mary's Haven
aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
tii Medical Certifier Name Title
CI; John Stoutenberg
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Numner
City, Town or Village Saratoga Springs 4501 /S'
❑Burial Date Cemetery or Crematory
April 21,2011 Pine View Crematory
Entombment
Address
❑x Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
NTransportation 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
= Remains are Shipped, If Other than Above
2. Address
14
AU
'IL' Permission is hereby granted to dispose of the human remai cri d ae indicat
Date Issued 0 / Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition t( ILA' Place of Disposition -PO4O11 Ci c f ar;tr•.
W (address)
U)
O (section) /� • (lot numbpi) (grave number)
p• Name of Sexton or Person in Charge of remises L (�r,5hjyr 31hrtt-
Z I (please print)
WArk
Signature Title OW.)t}ioi O.
(over)
DOH-1555 (02/2004)