Wolfe, Judith Marie ,tf
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permi
Bureau of Vital Records
Name First Middle Last Sex
Judith Marie Wolfe Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/19/2020 60 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
Ip Manner of Death 0Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Ej Pending
Circumstances Investigation
W Medical Certifier Name Title
G Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 480
ElBurial Date Cemetery,Crematory or Facility Name
10/21/2020 Pine View
EjEntombment Address
Cremation Queensbury Town,New York
Donation
ElRemoval Date Place Removed
and/or and/or Held
N Hold Address
0
0L. Date Point of
U) 0 Transportation
5by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
a Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/21/2020 Registrar of Vital Statistics XD6ert/lndrew Curtis gYectranicallySWned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z `
Date of Disposition /OkZ'Za Place of Disposition �n.-U/1cw.
(address)
W
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Char f Premises
(pease pm
W Signature S- Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) .. 1
Receipt
Human remains of delivered on 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#