Spring, Wendell NEW YORK STATE DEPARTMENT OF HEALTH ` II it tIGgo
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Wendell Lee Spring Male
Date of Death Age If Veteran of U.S. Armed Forces,
07/09/2014 73 years War or Dates
#-- Place of Death Hospital, Institution or
Z City, TowXXXX'i O( Glens Falls Street Address Glens Falls Hospital
Manner of Death g aatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
#Lt Circumstances Investigation
w Medical Certifier Name Title
0 Atilia Kayalar M D
Address
100 Park Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, Tow)MIOViDOPOJOC Glens Falls 5601 329
['Burial Date Cemetery or Crematory
07/11/2014 Pine View Crematorium
❑Entombment Address
121?Ctemation Queensbury, NY 12804
Date Place Removed
Z n Removal and/or Held
9..... and/or Address
H Hold
+
O Date Point of
13-❑Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
:if 0Reinterment 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
1 Remains are Shipped, If Other than Above
2 Address
lilt
fl' Permission is hereby granted to dispose of the human remains d-scribed ab ve as indic- ed.
Date Issued 07/11/2014 Registrar of Vital Statistics ���� - 2 T
/ (signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above we • disposed of in accordance with this permit on:
Z jr�'Date of Disposition ?-(S—l y Place of Disposition iw'Y'"44a [ 1P.iIir .J
(adss)
l ii
til
11 (section) number) (grave number)
el Name of Sexton or Person -n Char of Premises ipt
t naf
Z (pl se print)
iii
Signature t Title CI MN
(over)
DOH-1555 (02/2004)