Wyer, Carl 1- 11 >
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carl Leroy Wyer Male
Date of Death Age If Veteran of U.S. Armed Forces,
v,y, February 18, 2016 86 War or Dates
ePlace of Death Hospital, Institution or
' City, Town or Village Fort Edward Street Address FORT HUDSON HEALTH CARE FAC.
Manner of Death J Natural Cause Accident D Homicide Q Suicide Undetermined El Pending
Circumstances Investigation
WW Medical Certifier Name Title
P Philip J Gara Jr. MD,
Address
327 Broadway Fort Edward, NY 12828
die Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
February 19, 2016 Pine View Crematorium
4 ❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
7 El Removal
and/or and/or Held
F Hold Address
0 Date Point of
Transportation Shipment
'0 by Common Destination
1 Carrier
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
' Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
,c Address
Wr
a. Permission is hereby granted to dispose of the human woo.ins descri ed o e indicated.
i t Date Issued czV— (�"In"j_Q 1(registrar of Vital Statistics r i
(signatu )
District Number5755 Place )f ('IL `ik '6, Ed(IVCX/LC1
L. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iii Date of Disposition 02/19/2016 Place of Disposition Quaker Road Queensbury,NY 12804
W (address)
CO
te (section) (lot number) (grave number)
0.E Name of Sexton or Person in Charge f Premises 74:;+ StM14t-
Te A (please print)
W Signature Title l KdIC.,
(over)
DOH-1555 (02/2004)