Woodard, William NEW YORK STATE DEPARTMENT OF HEALTH # 2 Z
Vital Records Section Burial - Transit Permit
Name First Middae + Last Sex
William Raymond Woodard Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 13, 2013 68 War or Dates
i-- Place of Death Hospital, Institution or
City, Town or Village Hudson Falls Street Address 34 Pearl Street
Manner of Deathm
L.j Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 0 Undetermined ❑ Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Tucker Slingerland, Dr.
Address
Broad Street Health Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
`: City, Town or Village 51ACo 0
❑Burial Date Cemetery or Crematory
April 17, 2013 Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
E Hold Union Cemetery
V Date Point of
a° ❑Transportation Shipment
ff by Common Destination
I ,' Carrier
Date Cemetery Address
❑ 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
Address
LU
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued cJ—/S—,20/3 Registrar of Vital Statistics �,..k.9. - .�.0_,_ -L
(signature)
District Number 57 a 6. Place f-co—Qs/ n
I certify that the remains of the decedent identified above were disposed
pofinn accordance�^ with this permit on:
W Date of Disposition if I$-[3 Place of Disposition 'f►A)Livl C rA.T./i9ra-
(address)
W
(section) (lot number) (grave number)
C] Name of Sexton or Per on in Charge f Premises A) l.i.� '^'t�
j ( ease print)
LU Signature / �+.� Title CIZZA1n-` -
(over)
DOH-1555 (02/2004)