Woodard, Daniel t `a # 0
NEW YORK STATE DEPARTMENT OF HEALTH , , Burial
Vital Records Section Transit Permit e met
; Name First Middle Last Sex
Daniel M. Woodard Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 27,2015 45 War or Dates
1,° Place of Death Hospital, Institution or
Z. City, Town or Village Lake George Street Address 92 Bloody Pond Road
1,14
Manner of Death
X Natural Cause I I Accident 1 I Homicide Suicide Undetermined Pending
Circumstances Investigation
` Medical Certifier Name Title
John Stoutenberg MD
Address
102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Lake George 5651
❑Burial Date Cemetery or Crematory
❑Entombment August 31, 2015 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 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 00037
. Address
3809 Main Street, Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
#-A Remains are Shipped, If Other than Above
2, Address
rt
UJ
E1
,: Permission is hereby granted to dispose of the human remains described above as indicated.
Q� i
., Date Issued D" 3( - (S Registrar of Vital Statisti
(sig ture)
District Number ,S4,5- r Place T/O Lake George,NY
I certify that the remains of the decedent identified above were disposed of inaccordance with this permit on:
W Date of Disposition q/ s�� Place of Disposition 'P"(11—' to!`lu,..,
E
w (address)
co
QlL' (section) (lot numbe (grave number)
Name of Sexton or Person in Charge of Premises . ..pbok,.. 3ta N -
Z P (please print)
W �f
Signature lib- 4 Title ((1.eA1`
(over)
DOH-1555 (02/2004)