Wetmore, Winifred NEW YORK STATE DEPARTMENT OF HEALTH t Z
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Winifred C. Wetmore Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 8, 2012 73 War or Dates
F" Place of Death Hospital, Institution or
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City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑ Accident Homicide Suicide �Undetermined ri 1--1 Pending
i7l3 CircumstancesInvestigation
WW Medical Certifier Name Title
0 Mark Hoffman MD,
Address
420 Glen St. Glens Falls, NY 12801
£' Death Certificate Filed District Number Register Number
City, Town or Village 5601 14
❑Burial Date Cemetery or Crematory
January 12, 2012 Pine View Crematorium
am
❑Entombment Address
,1;®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
E., Hold
0° Date Point of
a.a. El Transportation Shipment
fJ# by Common Destination
Q Carrier
k-A Date Cemetery Address
0 Disinterment
1 ic Date Cemetery Address
ar ❑ Reinterment
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
Remains are Shipped, If Other than Above
Address
, Permission is herebygranted to dispose of the human mains scribed ove as in - •..
Date Issued O( ►0 aO% Registrar of Vital Statistics ` l�f � �7 1 G U e
i ignature
District Number 5601 Place //�� - n
7
I certify that the remains of the decedent identified above were disposed of in accordance with this ermit on:
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W Date of Disposition ,/i3/1Z Place of Disposition Inr ito uz on.A...
:a (address)
11.1
(section) (lot number) (grave number)
" Name of Sexton or Per n in Charge o remises r°S-i`'Qr t art {
1 (please print))
Signature !: Title (fZa `
(over)
DOH-1555 (02/2004)
(0 )
WETMORE LAND. 29 C
Address 1 4 Sycamore Drive, Oueen_s bury NY 1 2fi� 04 Section No.
Owner C- Brn Npt rP Plot
Frio
Date 1/27/2012 ( $600 . 00 )
ArrroX Superficial ft.
Location Bounded on the North by Vacapt, Fast by V3canr . awl
South by David
Corner Posts
Remarks 798-2857
Deed No. (and changes) 3760
Payment Record Paid in full on 1 /27/2012 (59,a00. 0))
Record of Interments V A C Pt N I
1A Winifred Wetmore (Crem) 7/21 /2012 Y
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x A
4 V
s A
1 2
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it VACANT
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Form No. 01
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NAME WETMORE, WINIFRED 1 LF i
Age: 73
Cause: Cremation
Lot Owner: C. Bruce Wetmore
Lot # 29 C Erie
Grave # 1 -A
Case # Ceramic
Died: 1 /8/201 2
Interred:7/21 /201 2
Undertaker: Carleton