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Wood, William Franklin
.. . ii 3-7c� r NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex William Franklin Wood Male Date of Death Age If Veteran of U.S.Armed Forces, 04/25/2021 85 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address 259 Mosquito Swamp Road,Argyle Town,New York 12809 W ❑Undetermined Pending W Manner of Death © Natural Cause 0 Accident 0 Homicide 0 Suicide Circumstances Investigation UJ Medical Certifier Name Title 0 Frank Westad NP Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 31 ❑Burial Date Cemetery,Crematory or Facility Name 04/27/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York 0 Donation Date Place Removed Z 0 Removal and/or Held and/or N Hold Address 0 r—iDate Point of t/) Li Transportation Shipment p by Common Carrier Destination Date Cemetery Address 0 Disinterment Date Cemetery Address 0 Reinterment 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 - 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 04/27/2021 Registrar of Vital Statistics Shelley 94ckgrnon(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- i Z Date of Disposition L,/Z'�I 21 Place of Disposition Lu 2. deIL .- W CC (section) (lot number) (grave number) 0 1. �►,,,,A41- Q Name of Sexton or Person in Charge of Pre ' es t r - Q (pleas iot) W C1140,if Title Pit Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014747 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#