Loading...
Woodbury, Paul NEW YORK STATE DEPARTMENT OF HEALTr '. Z t Vital Records Section Burial - Transit Permit o Name First Middle Last Sex Paul Thomas Woodbury Ma1P Date of Death Age If Veteran of U.S. Armed Forces, 4/21 /1 1 31 War or Dates No f•• Place of Death Hospital, Institution or izil City, Town or Village Saratoga Springs Street Address Saratoga Hospital a Manner of Death❑Natural Cause x❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending til Circumstances Investigation tu Medical Certifier Name Title Q Address Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 431 ❑Burial Date Cemetery or Crematory 4/2 5/1 1 Pine View Crematory ['Entombment Address ©Cremation Queensbury, NY Date Place Removed • • Z❑Removal and/or Held 4 and/or Address F_ Hold to 0 Date Point of , Transportation Shipment Q by Common Destination Carrier Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home 01 098 Address 82 Broadway, Fort Edward, NY 12828 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped, If Other than Above Durfee Funeral Home Address at 119 N. Main St. , Fair Haven, Vt. 05743 ILI CL Permission is he eby ranted to dispose of the human remai cri ed •b ve indicated. Date Issued ( Registrar of Vital Statistics --, (signature) District Number 4501 Place SARATOGA SPRINGS certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z • Date of Disposition 9 111./1) Place of Disposition Vqv 1�rrin4 tofx,� 2 (address) LEE U) re (section) (lot numb (grave number) O A Name of Sexton or Peron in Charge o Premises e.s� " r' �� wtt— (please print) Signature iii It k , Title COlu'7V}"�Ott Y (over) • DOH-1555 (02/2004)