Wendell, Daniel NEW YORK STATE DEPARTMENT OF HEALTH # L V 2.
Vital Records Section Burial - Transit Permit
AName First Middle Last Sex
Daniel Warren Wendell Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 28, 2013 58 War or Dates
Place of Death :.,: Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause El Accident ❑ Homicide El Suicide Undetermined El❑ Pending
Circumstances Investigation
•
Medical Certifier Name Title
Scott Biasetti, M.D. Dr.
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Or 1 Register; er
City, Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
April 30, 2013 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal
and/or Held
i. and/orHold Address
Date Point of
1 ❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
IllReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is her by ranted to dispose of the human r ains d ribed abwe as in ,icate .
Date Issued Registrar of Vital Statistics . G2
( )
District Number .�(o�j I Place � A;(--eetD
J
I certify that the remains of the decedent identified above were disposed of in accordance wi this permit on:
Date of Disposition 04/30/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) ii, (lot number) (grave number)
Name of Sexton or Pers.n in Charge f Premises r+`7� �oh.
9 lease print)
i
n, Signature i ��Title CP.J Viik L
�
(over)
DOH-1555(02/2004)