Hood, John (t4 \f
NEW YORK STATE DEPARTMENT OF HEA1.3I-
Vital Records Section ..,, Burial - Transit Permit
`: Name First Middle Last Sex
John William Hood Male
ni Date of Death Age If Veteran of U.S. Armed Forces,
(Y /n7/2n13 56 years War or Dates
Place of Death Hospital, Institution or
City, Tows 'i +2 4 X (lens Falls Street Address Glens Falls Hospital
a Manner of Death IffiNatural Cause 0 Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
CA
La Medical Certifier Name Title
O Robert Sponzo M D
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Tow9AtkiLailifhor Glans Falls 56n1 98
:El>< ❑Burial Date Cemetery or Crematory
❑Entombment 03/11/2013 Pine View Crematorium
Address
EiCrjemation Dueensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
F=" Hold
U
O Date Point of
Transportation Shipment
Cl by Common Destination
Carrier
Q Disinterment Date Cemetery Address
E Reinterment Date Cemetery Address
Iiii, Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
11 Lafayette Street Queensbury, N Y 12804
lii Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
2 Address
ilk
Ili Permission is hereby granted to dispose of the human remains described above as indicated.
iiiR Date Issued 03/06/2013 Registrar of Vital Statistics LA)C ''"'e„..-w
ft (signs re)
District Number Place
iiip 5601 Glans Falls,, N �%
ft I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tit 's- 24.1L
X Date of Disposition �-�g Place of Disposition ,N, t++,► Cn1c„'tar,rJti,-
2 (address)
ILI
l)
CC (section) /tot number) (grave number)
• Name of Sexton or Pers n in Charge o Premises : Sena-
++Z► (plea a print)
Signature Title Li tiMTftOe.
(over)
DOH-1555 (02/2004)