Woodman, Eleanor NEW YORK STATE DEPARTMENT OF HEALTH ID
Vital Records Section r . Burial - Transit Permit
Name First Middle Last Sex
FI.RANOR L- WOODMAN FEMALE
Date of Death 7,3 Age If Veteran of U.S. Armed Forces,
MAR- 4, 2 0 L? / War or Dates
1- Place of Death Hospital, Institution or
City, Town or Village NORTH ELBA Street Address
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O Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI ELIZABETH BARTOS, MD
Address
AMC LAKE PLACID 12946
Death Certificate Filed District Number Register Number
City, Town or Village NORTH ELBA 1560
CI Burial Date ' Cemetery or Crematory
MAR. 26, 2012 PINE VIEW CREMATORY
['Entombment Address
[JCremation GLENS FALLS, NY 12g04
Date Place Removed
Z Removal and/or Held
2❑and/or Address�
Hold
(I) —
O Date Point of
lt$ Transportation Shipment
ett v ❑
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to M. B. CLARK, INC. 01075
Registration Number
Name of Funeral Home
Address 2310 SARANAC AVE. , LAKE PLACID, NY 12946
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
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• Permission is hereby granted to dispose of the human rem "ns d ribe above as indicated.
Date Issued 0 3/2 6/12 Registrar of Vital Statistics ridal lr 13
ti/e
(sig ature)
District Number 1560 Place LAKE PLACID- NORTH ELBA
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
to Date of Disposition 3-Z7-tt Place of Disposition 'Pm Ow...) CcNe1droi,.._
2 (address)
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0
CC (section) (lot nu r) (grave number)
Name of Sexton or Person in Charge of remises (hr',rf ilI --)(Atilt"
r (please print)
la
SignatureAL Title Cie1'rt Mlti 0(
(over)
DOH-1555 (02/2004)