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Wight, Edward Allen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward Allen Wight Male Date of Death Age If Veteran of U.S.Armed Forces, 09/13/2021 80 Years War or Dates I-- Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p- Manner of Death © Natural Cause 0 Accident ❑Homicide 0 Suicide ❑Undetermined 0 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 54 ElBurial Date Cemetery,Crematory or Facility Name 09/14/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York 0 Donation 60 Removal Date Place Removed - and/or and/or Held H- Hold Address N 0 Date Point of Cl) Li Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑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 F Remains are Shipped,If Other than Above Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/14/2021 Registrar of Vital Statistics Aimee L Mahoney(6(ectronicalrySigned) (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: I— Z Date of Disposition 7/l5/,1.I Place of Disposition i n Q, v!c .' C.,re,/h pr Y LLJ 1 (address) W CC (section) (lot number) (grave number) CC er 0 Name of Sexton or Person in Charge of Premises J c,fine,y Slytr4.S (please print/ W Signature / Title C.re.,01(fi0 DOH-1555(07/18)p 1 of 2 0 1 F.;1, 4 5 1 Public Health Law Sec. 4145(2b) 1 Receipt : t . • ,„ . !, t i, 1 t , y1.1 k\, Human remains of • s-- -t ' C ' \ delivered on f i , , 20 .••'- ' itt 1' .4" :. , , •.V ././ • , ii/ .•:' e View Cemetery Representing the funeral home named oimpikriat.permit Official Funeral Directors Reg.or License# / 6.9 /41