Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Wilson, Russell Paul
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Russell Paul Wilson Male Date of Death Age If Veteran of U.S.Armed Forces, 11/29/2021 69 Years War or Dates 1969-1971 H Place of Death Hospital,Institution or WCity,Town or Village Moreau Town Street Address 9 Cedar Lane,Moreau Town,New York 12831 a Manner of Death © Natural Cause E Accident ❑Homicide 0 Suicide ❑Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title a Michael Adams MD Address 1448 Route 9,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 56 ElBurial Date Cemetery,Crematory or Facility Name 12/01/2021 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held H Hold Address CO 0 d I= Date Point of (!) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom .- Remains are Shipped,If Other than Above 5 Address EC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/01/2021 Registrar of Vital Statistics Leeann Mcca6e('EtectronicaCCySigned) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- WDate of Disposition /„-1-/-zi,Z( Place of Disposition 7i tJ e (,(1.e_LA.) 0 reili 2 (address) W Cl) / (section) ` (lot number) (grave number) 8 Name of Sexton or Person in Charge of Pre ise�/ R o6�0°"/ 'J 'I/w z / (p ease print) Signature Title UiaiTkAtkr- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 PineView Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#