Morin, Wendy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:�,,.�' Name First Middle Last Sex
r ' Wendy J. Morin Female
r: Date of Death Age If Veteran of U.S. Armed Forces,
February 28, 2015 57 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Gansevoort Street Address 29 Potter Road
Manner of Death X Natural Cause Accident I 1 Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Aqueel Gillani Dr.
"r', Address
1 102 Park Street,Glens Falls,NY 12801
:: Death Certificate Filed District Number Register Number
§s. City, Town or Village Town of Moreau 4562
❑Burial Date Cemetery or Crematory
El Entombment March 2, 2015 Pine View Crematorium
Address
Ii Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
F- Hold
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0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
I Disinterment Date Cemetery Address
-
Reinterment Date Cemetery Address
r`: Permit Issued to Registration Number
�:� Name of Funeral Home Regan& Denny Funeral Home 01444
r:{:r
a Address
r ;; 94 Saratoga Avenue, South Glens Falls,NY 12803
red Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above I: Address
.0 Permission is hereby granted to dispose of the human re ins de rib d above as indicated.
{'R' fally
;:: Date Issued .l�- / � Registrar of Vital Statistics
;r• (signature)
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f District Number 4562 Place Town of Moreau
gi
I certify that the remains of the decedent identified above were disposed ofin accordance with this permit on:
Z p Place of Disposition ta...• L, `�erw..
tu Date of Disposition 3 3 iS P
W' (address)
Cl)
O (section) (lot nu er) (grave number)
p Name of Sexton or Person in Charge of Premises _ d' 9v.vif
Z (please print)
W Signature i Title libimetVot
t (over)
DOH-1555(02/2004)