Woods, Thomas NEW YORK STATE DEPARTMENT OF HEALTH Z1
Vital Records Section Burial - Transit Permit
A Name First Middle Last Sex
•r• Thomas Edward Woods Male
•..: Date of Death Age If Veteran of U.S. Armed Forces,
r: February 24, 2015 54 War or Dates
IPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 17 Union Street
3,0 Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Timothy Murphy,Coroner
Address
'•*: Glens Falls,NY
;:;rr Death Certificate Filed District Number Register Number
;r_ City, Town or Village Glens Falls,NY 5601 ! QZ
❑Burial Date Cemetery or Crematory
❑Entombment February 27, 2015 Pine View Crematory
Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
rn
0 Date ? oiit of
NTransportation 1 Ship'. ,,. _
p by Common Destination
Carrier
Date I;(ometery.Address
Disinterment \eo
Reinterment Date Cemetery Address
Permit Issued to Registration Number
r Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
:. : Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
::: Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2/2-6 /i5 Registrar of Vital Statistics LZ ,
(signatu )
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W ��U Date of Disposition 2It1)gc Place of Disposition ti ,err,•,
2 (address)
W
U)
Q0 (section) �`(lot number),- (grave number)
Name of Sexton or Person in Charge of Premises C� 1. L 3¢,ri
Z ,�! / (p/ se print)
w g G'� �L�-- raker-RC - - -
Si nature Title
(over)
DOH-1555(02/2004)