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Hermance, Wanda Jean if NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Wanda Jean Hermance Female Date of Death Age If Veteran of U.S.Armed Forces, 01/10/2022 59 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare pManner of Death ©Natural Cause 1=1 Accident ❑Homicide Suicide ❑Undetermined n Pending W Circumstances Investigation Al Medical Certifier Name Title Joshua Started NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 2 ▪ Burial Date Cemetery,Crematory or Facility Name 01/18/2022 Pine View Crematorium ❑Entombment Address ▪Cremation Queensbury Town,New York ❑Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a= Date Point of t/1 ❑Transportation;; by Common Shipment 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 t- Remains are Shipped,If Other than Above 2. Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/18/2022 Registrar of Vital Statistics Skelrey ltckernon(E(ectronica1Ty 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: • Z Date of Disposition 1 /1 gI22 Place of Disposition 4:7,7A 1,,--er1J-- 2 (address) W CC (section) 4 (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises `y(t vu It (pie a print) W Signature v' Title (K all4 r0e— DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ..L j 5 Receipt Human remains of • delivered on , 20 • Pine View Cemetery Representing the funeral home named on purial permit Official Funeral Directors Reg.or License#