Loading...
Wicks, Anne ELF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Anne Wicks Female Date of Death Age If Veteran of U.S.Armed Forces, 02/08/2021 73 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare W Manner of Death Undetermined Pending W © Natural Cause �Accident Homicide �Suicide � Circumstances Investigation W Medical Certifier Name Title O Brandii Baker NP Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 19 ElBurial I Date Cemetery,Crematory or Facility Name 02/17/2021 Pine View Cemetery ElEntombment Address Cremation Queensbury Town,New York Donation Z• Removal Date Place Removed and/or and/or Held Hold Address 0 d Date Point of U) L j Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle, New York 12809 Name of Funeral Firm Making Disposition or to Whom 1.. Remains are Shipped,If Other than Above 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2021 Registrar of Vital Statistics Shelley Ifckernon(Electronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition @ 2/1 7/2021 Place of Disposition 21 Quaker Rd_ QucPnghury, NY 12804 (address) W Horicon 44 E 1 CC CC (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises Connie Goedert (please print) W Signature / '14.&LC �� Title Superintendent DOH-1555(07/18)p i of 2 Public Health Law Sec.4145(2b) Li 1284.3 Receipt ' , Human remains of s • - delivered on • , 20 - / • , • - Pine View denetery Representing the funeral home named on buriaLnennit - ' Official Funeral Directors Reg.or License# • WICKS LF NAME Age: 73 Anne Wicks Lot Owner: Anne Wicks /Social Service Lot# Horicon 44E Grave# 1 Case: Concrete Died: Interred: 2/8/2021 2/17/2021 Funeral Home: M.B. Kilmer FH Cemetery: Pine View Cemetery