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Wunschell, Carl NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Carl C. Wunschel Date of Death Age If Veteran of U.S. Armed Forces, 3-10-97 72 War or Dates WW II Place of Death Hospital, Institution or City, Town or Village Indian Lake Street Address PO Box 428, Joe Locke Rd- Manner of Death ©Natural Cause Accident Homicide ❑Suicide 0 Undetermined Pending Circumstances Investigation Medical Certifier Name Title Dan Way Address HHHN North Creek NY Death Certificate Filed District Number Register Number City, Town or Village Indian Lake 2053 Date Cemetery or Crematory ❑Burial 3-12-97 Pine View Cremator ®Cremation Address Queensbury, NY Date Place Removed 8❑Removal and/or Held ••• and/or Address > Hold Q Date Point of Q Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Adirondack Cremation Associates 02168 Address Warrensburg, NY Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above jo Address Permission is hereby granted to dispose of the human re ins described above as indicated. Date Issued 3-11-97 Registrar of Vital Statistics (signature) District Number 2053 Place T/0 Indian Lake, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t f p1 LU Date of Disposition ` Place of Disposition //V.�/�j,�1cJ° ��[.�/��/9ze— / t (address) t/J (section) (lot number y (grave number) GName of Se xto or Person in Charge of Premises kJ� hl� 1-9- k/ z (please print) r Signature Title DOH-1555 (10/89) p. 1 of 2 VS-61