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Woodward, William NEW YORK STATE DEPARTMENT OF HEALTH i W tri Vital Records Section Burial - Transit Permit Name First Middle Last Sex William Walter Woodward Male Date of Death Age If Veteran of U.S. Armed Forces, July 14, 2014 64 War or Dates Place of Death Hospital, Institution or w City, Town or Village Glens Falls Street Address Glens Falls Hospital W' Manner of Death J Natural Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined El❑ Pending Circumstances Investigation W Medical Certifier Name Title 0 Eric Pillemer, M.D. Dr. Address 102 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Register Number, City, Town or Village 5601 `f ❑Burial Date Cemetery or Crematory July 17, 2014 Pine View Crematorium ❑Entombment Address ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address 1 Hold CO Date Point of 0, ❑p,, Transportation Shipment CO by Common Destination Cl Carrier Date Cemetery Address El Disinterment Date Cemetery Address ❑ 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 I— Remains are Shipped, If Other than Above 2 Address W LL Permission is hereby granted to dispose of the human remains described o as/ i ated. Date Issued 07/6O/2©PV Registrar of Vital Statistics ,4� 4 l / (signature) District Number 5601 Place C�/6iw / 4 , ,etv F. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 07/17/2014 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W` G) C4 (section) (lot numbe (grave number) 0 Name of Sexton or Person in Charge of Premises 4,71_ j"N- Z ease print) IL Signature I` L-- Title C NC WV (over) DOH-1555 (02/2004)