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Wood, Dean NEW YORK STATE DEPARTMENT OF HEALTH v a g 37si Vital Records Section Burial - Transit Permit Name First Middle Last Sex 1 Dean R. Wood Male Date of Death Age If Veteran of U.S. Armed Forces, July 18, 2012 60 War or Dates ..E.; Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital 10 W Manner of Death Natural Cause Accident 0 Homicide El Suicide n Undetermined � Pending _ Circumstances Investigation W' Medical Certifier Name Title C Wendy Steinhacker, PA Address 9 Carey Road Queensbury, NY 12804 Death Certificate Filed District Number Register Number City, Town or Village v Q ( 3 6-) S ❑Burial Date Cemetery or Crematory July 20, 2012 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held O and/or Address H Hold mm CO Date Point of .. - 0. ❑ Transportation Shipment 0) by Common Destination Carrier LiDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2 Address IX a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued "7 I '2-L0 it-2.-- Registrar of Vital Statistics (_iJ ckAier , k,_A)..h/ c1L r (signature) District Number 55 w �5 l ) Place 6 �� \\ S 1 7✓ • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: uj• Date of Disposition 7-13-12 Place of Disposition �(' t.)In.t,, ( ,torw., 2. (address) WCO W (section) _ (lot number (grave number) 0' Name of Sexton or Person in Charge o Premises �h � � e .1t Z - ((please print) W �� / 't ht Z /L Signature Title k � (over) DOH-1555 (02/2004)