Wood, Frances NEW YORK STATE DEPARTMENT OF HEALTH ' ��
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frances J. Wood Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/03/2012 77 years War or Dates
1- Place of Death Hospital, Institution or
City, Toe.t(oXXti Saratoga Springs Street Address Wesley Health Care Center
Manner of Death Natural Cause D Accident 0 Homicide n Suicide Undetermined Pending
J Circumstances Investigation
tu Medical Certifier Name Title
CI Rick D. Teetz M. D.
Address
131 Lawrence Street, Saratoga Springs N Y
Death Certificate Filed District Number Register Number
i City, ItXXX0XXXXX Saratoga Springs 4501 97
El Burial Date Cemetery or Crematory
Entombment 03/O5/2012 Pineview Crematorium
Address
TigE]Cremation Queensbury N Y
Date Place Removed
2C ❑Removal and/or Held
and/or Address
h= Hold
W.
O Date Point of
ilii El Transportation Shipment
Gs by Common Destination
Carrier
Disinterment Date Cemetery Address •
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other than Above
• Address
a
ILI
'` Permission is hereby granted to dispose of the human rema' e ri d abo a as indicated.
Mi Date Issued 03/05/2012 Registrar of Vital Statistics I • --4-1/(11/ruilk
(signature)
MR District Number 4501 Place Saratoga Springs _
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
lLI Date of Disposition 3^5r -.orZ Place of Disposition ?;ne v ti,,0 L(`en+ait, vw1
(address)
UI
U)
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 1 m a4&y I l/,-,Ile-
(please print)
Signature! j„-- -ji uwe 1/ Title [rev.,c.(ol`7 tR4 0
(over)
DOH-1555 (02/2004)