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Woods, Thomas 4 41-112-7 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas Woods Male Date of Death Age If Veteran of U.S.Armed Forces, 12/28/2021 97 Years War or Dates WW II i_ Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital W Manner of Death NI NaturalCause ❑Accident ❑Homicide 0 Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Timothy Waters DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 778 ❑Burial Date Cemetery,Crematory or Facility Name 12/29/2021 Pine View Crematory 0 Entombment Address lCremation Queensbury Town,New York Donation © ❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 a Date Point of CO Li Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom — Remains are Shipped,If Other than Above S Address CC Ill O.. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/29/2021 Registrar of Vital Statistics John Paulfranck(ECectronwalTy Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: / Date of Disposition l�_3©-jz z(Place of Disposition I �,�i�'�� re -cr IJJ 2 (address) W CC (section) (lot nu ber) (grave number) SName of Sexton or Person in Cha of Premis )P 1J iVi b t'��C C z (please print) W Signature '177eft Title 0Ce_T d .-6 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 3. 9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#