Wright, Vance NEW YORK STATE DEPARTMENT OF HEALTH, /
Vital Records Section Burial - Transit Permit
; Name First Middle Last Sex
Vance Craig Wright Male
Date of Death Age If Veteran of U.S. Armed Forces,
November 11, 2013 44 War or Dates
Place of Death Hospital, Institution or
uj City, Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death❑ Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined Pending
€ ; Circumstances Investigation
W, Medical Certifier Name Title
Ci' Timothy Murphy,
Address
52 Haviland Ave Glens Falls, NY 12801
Death Certificate Filed District Number Registeer
ri,;, City, Town or Village 5601 f �(f
❑Burial Date Cemetery or Crematory
November 18, 2013 Pine View Crematorium
❑Entombment Address
Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
a and/or Address
Hold
Ai Date Point of
❑Transportation Shipment
„ by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
ElRenterment 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
Remains are Shipped, If Other than Above
• Address
it
WCL
_''
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued f)/i 2.11 3 ' Registrar of Vital Statistics �C4441--\.Q LA.L.A''citeit
(signature)
District Number 5601 Place 6to,„SFoas , iv y
F >
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
La Date of Disposition ill I it 113 Place of Disposition en.ek.)4 114, 6 c f>`
_ (address)
a
° (section) (lot number) (grave number)
14-
a• Name of Sexton or Person ' Charge of Pre ises g SQ"�
Z., (plebe print)
i Title G1lien M L
,e Signature
(over)
DOH-1555 (02/2004)