Wood, Dorothy NEW YOR STATE DEPARTMENT OF HEALTH
Vital Records Section ,; Burial - Transit Permit
Name First Middle Last Sex
Dorothy G. Wood Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 13,2015 98 War or Dates
1 Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Westmount Health Care Facility
G►'1 Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Ili Circumstances Investigation
u Medical Certifier Name Title
0' Roslyn Socolof
Address
100 Broad St.,Glens Falls,NY 12801
DeCit , icategFile.`�, 4 D Cig c-. 'Thr RIgis2er�Vumber
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❑Bu idl Date Cemetery or Crematory
Entombment December 15,2015 Pine View Crematory
Address
®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
a.
Transportation Shipment
'p by Common Destination
Carrier
Disinterment Date Cemetery Address
1-7 Reinterment
Date Cemetery Address
1 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
i. ° Remains are Shipped, If Other than Above
Address
:1
7k, Permission is hereby granted to dispose of the human remains described above asindicated.
�Date Issued�. 1 /S I p I Registrar of Vital Statistics __ `� N
(signature)
District Number cQ'ce--) Place 1 n�� scy-( ��j
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I certify that the remains of the decedent identified above were disposed of in accordance with ' permit on:
Z
tuDate of Disposition /2-/( ,y Place of Disposition J2 n2 1/rB0J G/•errrSvr
w (address5
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QCL (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises -31,/,'a.,n KG,ry►G-,4e
Z (please print)
W Signature Title £rLma. y 4S5•3-74 ,-
(over)
DOH-1555 (02/2004)