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Wood, Mary
E a i I # 6Nb NEW YORK STATE DEPARTMENT OF HEALTH Permital - Transit Vital Records Section Name First Middle Last i Sex Mary Ann Wood i Female Date of Death Age if Veteran of U.S„Armed Forces, 9/14/2016 1 7l War or Dates - t- Pl of Dead ' Hospital, institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death t Natural Cause 0 Accident Homicide 0 Suicide Undetermined ri Pending Circumstances Investigation l Medical Certifier Name Title Ci Paul Bachman Dr. Address 3767 Main St. Warrensburg, NY 12885 Death Certificate Filed I District Number ) i Register Number�. I City, Town or VillageGlens Falls 5CCO- e Date i Cemetery or Crematory Burial 9/16/2016 1 Pine View Crematory DEntombmeat Address OCremation 21 Quaker Road,Queensbury New York 12804 _ Date Place Removed Z o Removal and/or Held and/or -Address — .,..,._._ ,. .. .,,. ...� ,�._. Hold f Date i Point of Di Transportation Shipment 5 by Common Destination , Carrier l bate I Cemetery Address 0 Disinterment 1 i f einterment Date Cemetery Address Permit Issued to ; Registration Number Name of Funeral Home M.B. Kilmer Funeral Home - South Glens Falls 01078 Address 136 Main Street, South Glens Falls,NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shy , if tither than Above Address CC Permission is hereby granted to dispose of the human reru ns de. ., bed above as in. sated Date Issued © / • Registrar of Vital Statistics ,� _` mow_ .:, ,�/ '.-_- (sgrnaau€e) District Number Place I I certify that the remains of the decedent identified above were d spored of in acc6rdance wi this permit on: q/ J Place of Disposition (+u ,` Date14. of Disposition i t 1 /�� _ _� '"J C Imo' (addra ) Di tea} { (dal nttrrstrar# (grave ) Name of Seaton or Person in Chargeof Premises �[ �4,^ t rr z t se r/ Cfzem Signature C: _ _ Title (over) DOH-1555(02. )