Wendell, Carlene NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carlene F. Wendell Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/16/2014 76 years War or Dates
1-- Place of Death Hospital, Institution or
illCity, reA.XXX Glens Falls Street Address Glens Falls Hospital
W• Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
O.
tu Medical Certifier Name Title
G Nancy D. Carney M. D.
Address
Warrensburg Health Center Warrensburg, NY
Death Certificate Filed District Number Register Number
City, TowXjQX illegi(XX Glens Falls 5601 481
❑Burial Date Cemetery or Crematory
❑Entombment 10/22/2014 Pine View Crematorium
Address
'pQpemation Queensbury, NY 12804
Date Place Removed
P❑Removal and/or Held
and/or Address
~ Hold
N
O Date Point of
0) Transportation Shipment
O by Common Destination
in Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox& Regan Funeral Home 01821
Address
11 Alqonkin Street Ticonderoga, N Y
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
• Address
tr.
W
z.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/17/2014 Registrar of Vital Statistics (A) ,r_g_ (N� atur te n '
(si e)
District Number 5601 Place Glens Falls)) t
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ill Date of Disposition to/n I i j Place of Disposition giLe ei *,.s
2 (address)
ILI
CC (section) (lot number) (grave number)
CI• Name of Sexton or Person in Charge of Premises �� ,, ��+^0171
'
2 jii (pl se print)
• Signature C C, 4 Title CAR 01 Rik
(over)
DOH-1555 (02/2004)