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Wetmore, Charles Bruce 4 2--no NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Bruce Wetmore Male Date of Death Age If Veteran of U.S.Armed Forces, 03/13/2021 82 Years War or Dates F- Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death ©Natural Cause 0 Accident ❑Homicide 0 Suicide Ei Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title C Carrie Miron PA Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 17 ❑Burial Date Cemetery,Crematory or Facility Name 03/16/2021 Pine View Crematorium IDEntombment Address X❑Cremation Queensbury Town,New York 0 Donation Removal and/or Date Place Removed and/or Held H Hold Address N 0 a. Date Point of to Li Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address CC W E' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/16/2021 Registrar of Vital Statistics Aimee G Mahoney(Electronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on. W Date of Disposition 3/Il (11 Place of Disposition addres1L. W NCC /section/ fi number) — (grave number) O▪ Name of Sexton or Person in Charge of miser A \" .nn,b}1 (please int / W (� / Title l V✓1f ��� Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014544i, Receipt Human remains of ' ..;delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Charles Bruce Wetmore were cremated on March , 17 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death March , 13 20 21 Age 82 (Month) (Day) Funeral Home Carleton Funeral Home Registered No. 276 /i (Authorized Signature) (0 ) WETMORE Lot No. 29 C Address 14 Sycamore Drive, nueensbury. NY_ 12804 Section No. Owner C BrurP mot_ rcl Plot Fr_ic Date 1 /27/2012 ( $600 . 00 ) ArDrQx 111, Superficial ft. @ Location Bounded on the North by Vacant. East by Vacaat, and South by David Corner Posts Remarks 798-2857 Deed No. (and changes) 3 7 6 0 Payment Record Paid in full on 1 /27/2012 ( 4,400. (0) Record of Interments VACANT to Winifred Wetmore (Crem) 7/21 /2012 3i41.-.- 9-0- a Dx / � - A A l`l• 1 Z X s c/5 4 s A 2 -1- �� � VACANT YNI Form No. 01 C 7 WETMORE NAME Charles Bruce Wetmore Age: 82 Lot Owner: C. Bruce Wetmore Lot# Erie 29 C Grave# 2 Case: Urn Died: 3/13/2 0 21 Interred: 7/1 7/2 0 21 Funeral Home: Carleton FH Cemetery: Pine View